“My nerves are shot!”

For the uninitiated, “My nerves are shot!” is a phrase very commonly heard by this wandering pilgrim in his days seeking to help those suffering from seemingly insurmountable anxiety and stress.  It basically means, “I can’t take all this anxiety anymore!!  I’m completely beaten down by all of it!  Please help!!!!”

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After hunting around, I managed to find some pictures that illustrate the following fact:

Even though I myself might not have the courage to trust in rickety, rusty, rotting stairs to climb to the top of tall belfries, and then to lean out over the top to look down at the tiny buildings, cars, and people below, some folks DO possess this bravery, and I tip my hat to them!

For example, these young ladies certainly had a lot of intestinal fortitude while mounting up to this belfry at the top of the Basilica in Quito, Ecuador:


But, once they reach the top, what a view they received as their reward!!

Amazing!

And then here is another young man who overcame, undoubtedly, tremendous fear to climb out onto the precipice of imminent disaster to capture great photos:

I’ve got to hand it to him … he’s got a ton of courage!  Courage which I do not possess.  And likely never will.  Which, taken with the long range view in mind, is perfectly ok by me.

I do very much appreciate the photographs he has given the rest of us, though!

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As we decided in our last installment (well, at least I decided!) anxiety is the degree to which our bodies are activated, in any given situation, moreso than is needed to deal with that situation.   And as we also talked about, anxiety disorders are extremely common, with as many as 40% of American adults having a diagnosable anxiety disorder at some point in their lives (in many cases, for their ENTIRE lives!).  That means 2 of every 5 of us will be impaired by anxiety in some way, shape, or form during our journey!  This outnumbers almost any other illness we might ever face.  And as such, anxiety disorders ought to be taken very seriously.

Now, we also discussed the fact that there is a very big difference between having an “anxiety disorder”, and having an “anxious” or “fearful” state of mind.  This is a huge distinction, and we’ll talk more about that later on, down the road.

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Currently, the most common form of treatment for anxiety disorders is medical, i.e., medication.  Whether it ought to be or not is a debate for another venue and time.

There are 3 primary classes of medicine used to help people with anxiety disorders:

1)  Tricyclic Antidepressants:  The word “tricyclic” refers to their chemical molecular structure.  The word “antidepressant” means that all of these medicines were originally marketedas antidepressants.  It has very little to do with how they actually work within the nervous system.  And they are used to treat far more than just depression.  Anxiety, chronic pain, insomnia, migraine prevention, etc. are all within their purview these days.   The class includes:  Amitriptyline (Elavil), Nortriptyline (Pamelor), Desipramine, Imipramine, Clomipramine (Anafranil), Doxepin, and Trazodone, among others.

2)  SSRIs (aka, Selective Serotonin-Reuptake Inhibitors):  This class also is primarily considered to be “antidepressants”, but once again, we find them being used to treat other problems, most especially anxiety.  The list includes:  Fluoxetine (Prozac), Paroxetine (Paxil), Sertraline (Zoloft), Citalopram (Celexa), Fluvoxamine (Luvox), and Escitalopram (Lexapro).  All of these medicines can lessen anxiety, though they typically take longer to achieve this dampening effect.

3)  Benzodiazepines.  This is by far the most effective class of medicine if you simply want to lessen anxiety in its global context.  It includes:  Diazepam (Valium), Alprazolam (Xanax), Clonazepam (Klonopin), Lorazepam (Ativan), Chlordiazepoxide (Librium), Clorazepate (Tranxene), etc.

The problem with “Benzos” is that they have developed a negative connotation and reputation for many people, both inside and outside of the mental health profession.  ‘Tis true, some people do abuse benzodiazepines.  A slender few become addicted to them.  Not even close to a majority, but that fact seems to matter little to many people.  In my experience, VERY few people who truly do struggle with a real anxiety disorder will ever abuse their medicine.  They simply want relief!  NOT to get high.  But, as with so many things, a few people with selfish or unhealthy intentions can often ruin things for many others, and this has been the case with these medicines.  However, it is also true that many prescribers have too often written scripts for these medicines without really finding out whether and to what degree their patient actually has a crippling anxiety problem.  I have been guilty of this at times.  Most of the time, though, when I prescribe such a medicine for someone, I have been careful in the diagnosis, but I do often choose to trust people until such time that they might prove to be not trustworthy.  The vast majority of the time my trust in them has been well-founded, and they end up very grateful for the help with this hugely disabling condition!

There are other medicines commonly used to help with anxiety, but they are usually fairly unique-type meds, not a part of a larger class.  Examples include Buspirone (BuSpar), Hydroxyzine (Vistaril or Atarax), Gabapentin (Neurontin), and a couple of other more obscure medicines not used much in a number of years.

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However, there are other ways beside medicine to treat anxiety disorders.

There is what is called, “Cognitive Therapy”.  This is a form of treatment in which you work with your therapist to identify some of the “automatic thoughts” that go through your head in certain situations.  In this case, these would be situations in which you ordinarily begin to feel symptoms of anxiety arise within your body.  Then, while you are in a safe and calm place, you begin to REALLY examine these thoughts, as well as the beliefs that underlie them, and see just how true and accurate these beliefs and thoughts actually are.  For any of us who do this sort of exercise, we quickly realize that there is an incredible amount of pure junk (I wanted to use a word that includes a large case ‘B’ next to a large case ‘S’ here, but as this is a “family” forum, I’ll stick with ‘junk’!) percolating around in our minds, and it has a huge impact on our lives.  But, again, that’s a discussion for another day.

As you identify the falsehoods and silly thinking or logic that permeates your belief systems, you begin to try to change those automatic thoughts with other self-talk which you, yourself, script out.  Some people will actually write down a few “true” statements on a 3×5 index card and carry it around with them, to pull out whenever they start to feel anxious.  You could also write a few such lines on your cell phone.  As you begin to practice responding with more accurate statements about yourself, the situation, the worst case scenario, and other “outside-the-box” choices you can make for yourself in that instant, and as they become more habitual for you, the less your anxiety and worry become.

Almost all forms of therapy are really exactly like this, though other forms don’t have the specific “homework” assignments that cognitive therapy does.  They are all about looking at what we do (and feel and think), why we do it, and how unsound our thinking is that undergirded the reasons why we did so.  Then we look deeper to find truths about ourselves and others around us, and try to build our future upon more truthful and sound foundations.  Some therapies will have us delve back into our childhoods, or walk through traumatic experiences over again, or examine the relationships we had with our parents, or siblings, or various authority figures, etc.  But the goals are still pretty much as I’ve laid out above, when you distill them all down.

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Other forms of treatment are not exactly “therapy” in the common lingo, but they are still ‘therapy’ in the purest sense of the word!  These other forms I categorize as “Mind over Matter”!  Or, in this case, “Mind over Body”!  These forms include such things as Biofeedback, Deep (Abdominal) Breathing Techniques, Progressive Muscle Relaxation, and Visual Imagery.  In addition, while they are not specifically treatments for anxiety problems as the things listed above are, Yoga, T’ai Chi, Pilates, and other forms of exercise which emphasize breathing, flexibility, and mindfulness, are excellent tools for people to explore who deal with anxiety disorders.

In all of these endeavours, the goal is for the person practicing these things to maximize one’s control over one’s body.  To slow things down to at least a manageable level.  When we again think about how the body automatically begins spitting out huge amounts of adrenaline (epinephrine) and norepinephrine in response to, say, standing on the parapet of a 500-foot tall belfry, and how this leads to dramatic increases in heart rate, breathing rate, cold sweats, dizziness, churning guts, shaky hands, weak knees, and a strong feeling that we may very well die, the one thing we would most wish for is the ability to control some of this, so we could make it go away!  If by deepening and slowing our breathing, or by closing our eyes and imagining ourselves in a “safe place” (for me, it’s always been sitting on the sand at Holden Beach, North Carolina, on a warm, breezy summer day, with the constant and soothing sound of the surf driving all fear from my mind!), we can actually direct our bodies to shunt some of that adrenaline away and feel quickly less tense and panicky, so much the better.  The best thing about these techniques, if practiced repeatedly, is that they can be called upon at any time in any place, and no external chemical is needed!

Actually, one of the best non-specific treatments for anxiety is to simply exercise.  Walking or running, or any of the numerous forms of dance-type exercises now popular … really, any kind of what is called “aerobic” exercise … will help build resistance in your cardiovascular and respiratory systems to the over-stimulating effects of adrenaline.  I often tell my patients of the stories I saw a number of years ago during a summer olympics broadcast of a couple of marathon runners who first started out running, in response to their doctor’s recommendation that they start exercising as a way to prevent or lessen panic attacks.  Lo, and behold!  They became world-class long-distance runners, and had no more panic attacks to boot!  Now, of course, one does not need to run 26.2 miles in 3 hours or so in order to overcome panic disorder … but you get the idea.   🙂

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I’ve very superficially described only a few of the many treatments available for anxiety disorders.  Some of these disorders, such as Obsessive-Compulsive Disorder, require very intensive treatments that have to be tailored to that person’s specific patterns and O-C drives.  Social phobia or specific phobias (such as fear of heights!) will often require a form of therapy known as exposure, or progressive desensitization, to help someone go from the panic caused by even the mere thinking about the thing they dread, to actually being able to be in that situation for several minutes, and to see that you CAN live through it and do okay.

The one thing I have hoped above all in these last two posts is to convey the truth that if you or someone you care about is dealing with some kind of anxiety disorder, there is hope.  In many cases the hope is that it can be managed better, feel better, and NOT be an obstacle to living a normal and happy life, or to achieving your goals and dreams.  In some other cases, there is good hope for a complete cure … learning and finding a way to live free of whatever anxiety has haunted you for so long.  Either way, I urge you to seek help, as it is out there.

I wish you calmness and peace.

Craig Meek, M.D.

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High Anxiety!!

Are you scared of heights?

I am.  I’ve stood and walked along with my feet supported only by the narrow edges of two 2×12 boards, two stories above a base floor, my mouth bone-dry and my hands sweating like crazy.  I’ve leaned out to look over the side of a number of cliffs, with my heart pounding and legs shaking, feeling very lightheaded, and desperately hoping no one would push me from behind.  I’ve been up in the Washington Monument and a number of other tall towers and places, and aside from the steel-vise grip my hands had on the hand rails, all I could think about was how happy I would be once we got back down onto solid ground!

If you had been standing next to me in those moments, it is very likely you would not have had a clue of how nervous I was feeling.  I, like most people out there, are often very good at hiding these internal symptoms.  But that does not mean those symptoms are not there, and are not wreaking major havoc in the lives of many thousands … no, make that millions, of people who suffer from them.

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Here are a few pictures, looking down from various belfries around the globe.  As you can see, bell towers can provide wonderful viewpoints from which to see the world around you.  This is one of the reasons why I like to imagine myself sitting or pacing around inside belfries as I contemplate various human problems.  Unfortunately for me, looking down from them, or even simply viewing pictures others have taken while looking down from them, causes a little fear to grow inside me … even as I type this my hands are just a tiny bit sweaty!

Now, here are a couple of views from the top of the world’s tallest building.  Unfortunately, it is not a bell tower (yes, I cheated … sorry!), but it IS very tall!  This is the Burj Khalifa building in Dubai:

I realize that for many of you these fears about being or standing in high places may seem puzzling, silly, or even ridiculous.  I am quite certain most of these amazing guys would agree with you:

By the way, this famous picture, entitled, “Lunch Atop A Skyscraper”, was taken by a man named Charles Ebbets, and was published in the New York Herald Tribune in September, 1932.  These guys were working to build the GE Building in Rockefeller Center, and they are sitting 800 feet off the ground while eating their lunch and smoking their smokes!

Here are two or three of them who posed as if napping afterwards:

Simply amazing.  I do not see any way you could get me to sit out on a 20-inch wide beam and eat my lunch 800 feet off a very hard earth.

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However, whether or not heights get to you, or spiders, or snakes, or dark alleys, or elevators, or crowded stores, or talking to women, or speaking in front of an audience, or being slid into a very narrow MRI or CT tube, or having a gun pointed at you, or driving on I-65 amongst a sea of speeding trucks, if you are human then there are certainly some things that trigger in you what most of us would call fear.  You simply are not being entirely honest if you deny this.

And if you are one of the very fortunate and very small minority for whom only a few things in life make you feel fearful or scared, then good for you.  God has gifted you with wonderful chromosomes!  And please don’t feel too highly about yourself … it truly is, according to research and the common sense of many of us who work in mental health, the luck of the reproductive draw, more than any other factor, that gives you the ability to feel calm in the face of so many things that most of your brothers and sisters recoil from.  Not only this, but I believe that part of what comes with this blessing is that you have a duty in life to help encourage those around you who unfortunately are more naturally fearful.  It is part of your calling to help them face their fears, and do things they need to do to fulfill their own callings in life.

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So let’s talk about anxiety.  The various symptoms I described above, as well as many others we humans have all experienced in life, are all various ways that anxiety can manifest itself.  Sweaty palms and/or forehead, lightheadedness, feeling jittery, nausea, feeling our heart racing, pounding, fluttering, or skipping beats, breathing faster, breathing shallower, feeling as if you can’t breathe, or as if you’re smothering, feeling a tightness in your chest, “butterflies in your stomach”,  tingling sensations in your fingers, hands, or arms, dry mouth, a “lump in your throat”, your voice cracking when you try to speak, feeling unable to concentrate, weakness or wobbling in your knees, feeling “rubber-legged”, feeling like the “walls are closing in” on you, and any kind of a strong desire to get away from whatever situation you’re in when you feel any or all of these things … all of these and probably other symptoms, too, are part of what we refer to as anxiety.

As you can see, most of what I’ve listed here are what would be considered “physical” symptoms.  That is, almost all of the above are things that our bodies feel.  They are part of our physiology.  There are also, of course, “emotional”, “mental”, and even “spiritual” symptoms of anxiety and fear.  In fact, very few things in life so well illustrate the connections between soul, mind, brain, and body as the whole experience of anxiety.

To a large degree, anxiety is a highly biological phenomenon.  It really could, in a sense, be measured on a meter or gauge, if such a meter could be properly wired up.  In its most basic sense, anxiety is simply a heightened level of biological arousal.  It can be triggered both by our bodies, such as by a sudden and loud crash of thunder when we’re sitting at home or work, previously unaware that a storm was brewing, or by our minds, such as when we look at the clock and then realize we’re about to be late for work or class, and then our brain tells our body to get hyped up and get moving!

Anxiety can be slight, medium, high, or “through the roof”!  In small amounts, anxiety can be very helpful to us.  To accomplish almost anything other than sleeping requires that our energy, both mental and physical, be mobilized in order to do the tasks we need to do.

Arousal, or the lack thereof, can be pictured as a continuum, from lowest to highest:

1) Comatose (essentially no higher brain functioning);

2) Asleep, deeply;

3) Asleep, medium depth;

4) Asleep, lightly;

5) Asleep, in dream phase, or REM;

6) Stuporous (half-asleep, half-awake);

7) Awake but drowsy, sluggish (aka, lethargic);

8) Awake, calm, slow-moving, slow-thinking;

9) Fully awake, alert, normal-thinking, moving around at normal pace;

10) Awake, moving around quickly;

11) Mildly anxious and tense;

12) Moderately anxious and a little fearful;

13) Highly anxious and nearly panicky;

14) Full panic / “crawling-out-of-our-skin fearful” mode.

The level of arousal or anxiety we experience at any given moment is controlled through our nervous system (which is more than just the brain – it also includes the spinal cord and many, many nerves coursing through our bodies – but for the moment to simplify things we’ll just refer to it as our brain).  The way our brain does this is mostly via electrical impulses sent through nerve fibers to various parts of the body, as well as back and forth to and from the thinking and emotional parts of our brain.  Some of those nerve impulses go to various glands in the body, telling those glands to release or to withhold various hormones that either raise arousal levels, or lower them.  One such pair of glands are the adrenal glands, located right next to our kidneys.  The adrenal glands produce several hormones, but the chief of these has long been known as “adrenaline”, named after the glands.  The more correct name for this chemical is “epinephrine”.

As you might imagine, knowing how commonly we refer to adrenaline in the context of being “hyped up”, epinephrine is a highly stimulating chemical.  As it is released into the bloodstream and then flows throughout the body, attaching itself to receptor proteins on the outside of cells in blood vessels, muscle fiber bundles, the heart, breathing muscles, airways, etc., all things tend to be mobilized for our basic biological “fight or flight” mode.  Epinephrine’s close cousin, norepinephrine, is primarily a stimulating neurochemical.  At the same time that epinephrine is being released into the bloodstream, norepinephrine is being spit out from the ends of stimulating nerves to receptor proteins in heart, airways, muscles, the GI tract, the pupil muscles in the eye, nerves that control hearing, sweat glands, even the tiny muscles that make the hairs of our skin “stand on end”.

The end result of all of that is that we become ready for action, with blood flow being maximized to places we need it most if we’re going to “fight or to flee”, and minimized to those places, such as the skin and GI tract, where it won’t be needed until things are calmer.  Our hearing and vision are keener, our brain is ready for quick decision-making, less so for humor or reflective thinking, and our heart and lungs are working quickly to keep the troops (the muscles of the arms, legs, and core) well-supplied for their mission.

When there is a good balance set in the amounts and timing of these stimulating actions, we are ready and able to go out and play a basketball game, or to get the house straightened up when we find out that friends are coming over in 15 minutes, or to deal with a power outage, or any of a number of tasks that are common for all of us in life.

However, when, as is very often the case, our nervous system easily goes too far in its arousing activities, we find ourselves far more stimulated than we need to be.  This “overkill” is what I call “anxiety”.  It’s the degree to which our system activates itself more than it needs to for a given situation.  Many, many of us have such nervous systems.  They are geared to go overboard to prepare us for certain situations, or they overreact when we are faced with “alarms going off”.

When such nervous systems routinely over-prepare or overreact, to such a degree that it causes problems for these persons, this is what we call an “anxiety disorder”.  Anxiety disorders include:  1) Generalized Anxiety Disorder, in which these folks are almost always mildly to severely anxious, in almost all situations, which makes life very uncomfortable (although, they rarely suffer what are called panic attacks);  2) Panic Disorder, in which people do have sudden panic attacks, or severe explosions of debilitating anxiety, either in certain situations such as in crowded malls or crowded elevators, or just anytime, including even while they’re sleeping!  3) Social Phobia, in which people are very fearful and anxious whenever they are have to be around unfamiliar people or have to perform in front of folks;  4) Post-Traumatic Stress Disorder, in which persons who have been in, suffered, or closely witnessed near-death or severe trauma, or repeatedly or continually have been in mortal danger (such as soldiers in Vietnam or Afghanistan, for example), experience recurring memories of the trauma, are almost constantly hyper-aroused due to the trauma, and try to avoid anything that might trigger memories of the events, and live very anxious lives because of it;  5) Obsessive-Compulsive Disorder, in which people live very anxiously because of some fear-inducing obsessive thoughts that drive them to do compulsive things over and over again, to such a degree that it keeps them from living normal lives;  and 6) various other less common disorders, all with the common theme of overriding anxiety that manifests itself more than normal.

In the United States, anxiety disorders are the most common form of mental illness in adults, as around (by most sane estimates) 40% of adults have or will have a diagnosable anxiety disorder at some time in their lives.  This compares to ~20-25% for Major Depression, 2-5% for Bipolar Disorder, and 1% for Schizophrenia.  As you can see, this is a huge issue for many people!

Most people with anxiety disorders, as I mentioned earlier, are wired this way from the time of conception.  Some people develop them due to having experienced severe traumas, abuse from parents, other adults, or bullying kids while growing up, overly protective parenting as children, and other experiences which somehow taught them to think or live in very tense ways.  For others the anxiety disorder arises from a combination of the two (genetics and life experience).

The bottom line is that anxiety and anxiety disorders do not arise due to mental or spiritual weakness, social incompetence, or a lack of faith in oneself or in God.  And no one should feel ashamed or inferior if they find that they are frequently running into obstacles in their lives because of anxiety in one of its forms.

But, is there hope?  There certainly is.  We will see in our next installment that there are very good, fairly simple, and quite effective ways of reducing, managing, and learning to live better with, anxiety.  We will also see that there is a big difference between anxiety, as we’ve been discussing herein, and fearfulness.  Fearfulness, or “being anxious”, is more of a state of mind, and that is a different kind of animal.  No one HAS to live in a state of fearfulness, but we’ll talk more about that next time.

Please stay tuned!

Craig Meek, M.D.

The Campfire

There will be no pictures of belfries in this post.  Sorry.  Hope no one is too disappointed.

I am, though … a little.

I’m going to talk about campfire scenes, such as the one below, in this entry

and unfortunately, try as I might, I could not find any pictures of bell towers next to campfires, or of campfires burning inside belfries.

But, there will be pictures, and if I could have found a suitable belfry pic, it would have been here.  I’ll try to do better next time!

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Actually, a campfire is one of those things that for me always brings up good memories.

Family gatherings, listening to the grown-ups reminisce and laugh about old tales from their past …

while we kids made S’mores …

On Boy Scout camping trips,  telling and hearing ghost stories around the fire late at night …

At church-run summer camps, singing and having vespers before roaring fires …

And with friends, sitting around blazing fires until they became dying embers, cutting up about various topics in summer and fall evenings during my teenage years

Recalling these things consistently brings a smile to my face.  Maybe you, too, have some good memories of campfires from your distant past, or maybe from just last summer!

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Several years ago, when I was in therapy myself, I was introduced to the concept of the “child within”.  Ever heard of this idea?  It is based on the fact that when we experience strong emotions such as fear, joy, anger, frustration, curiosity, etc. as adults, we tend to react initially in much the same way as we did the very first time we felt those feelings.  And that, of course, would have been as children.  It is also based on the fact that most of our beliefs about life and what is really important about life, about ourselves, our value, and our place in the world, and about the world itself, were all set in place when we were children.  And finally, it refers to the fact that our personality – the way we tend to see and interact with the world around us – is not entirely “fixed” as infants.  It develops and changes as we go through the growth stages of our childhood and adolescence.

Any number of factors can influence our personality development, and it may be possible to identify one or more different childhood personalities that became dominant “default” modes for us as we grew up.  As adults we tend to “put on” these identities, in the same way that we change into different outfits of clothing in different situations, depending on the emotions we may be feeling, or the statements, based in both our childhood beliefs and our childhood emotional reactions, that we are telling ourselves at any given time.

As I reflected on this idea, and spent a lot of time writing in my journal about this, it became clear to me that in fact, there were three distinct “ages” of child in me that exerted strong influences in my adult life.  These three personalities still play a large role in how I interact with others, and definitely affect the choices I make.

These personalities for me are:

1)  First, there is a 2 year old.  This is the little boy who absolutely loves life and the world he lives in.  Life is fun for him!  He is curious about everything, but is also the most innocent and natural part of me.  He has no desire to hurt anyone or anything, but has very little concept of boundaries.  He wants to know everything about everything, AND everyone.  He loves to explore things and places around him.  He greets the world with a smile and with questions.  This is the mode that is most active for me when I am feeling happy, joyful, unafraid, carefree.  Unfortunately, he is the part of me who was most squelched as life went along.

2)  Next, there is a 10 year old.  He is, above all else, a people-pleaser.  Secondly, he is a perfectionist.  Thirdly, he is very shy.  This part of me was extremely strong through the first half of my adolescence, and for about the first 10-15 years of my adulthood.  How or why these characteristics arose in me by the age of 10 I will likely never know for sure (though I have a pretty good idea), but they were there, and they encapsulated my personality at that age very well.  He responds very strongly to fear, and will do almost anything to avoid conflict and tension.

3)  Finally, there is the 17 year old.  This guy is his own spirit.  He is a rebel.  He takes risks.  He folds his arms and shuts the world out.  He does not trust very many people at all.  He loves to feel floaty-headed.  He believes the world is sick, keeps secrets from him, and that he must guard himself against it.  He feels very misunderstood.   He likes excitement, rock music, driving fast, and sports.  Anger and resentment bring him out quickly and suddenly, and he can go on the attack without much warning at all.

Out of a mix of these 3 developmental “parts” of me grew what I like to call my “Responsible Adult” part.  This one is the wise “Craig” who is able to listen to and appreciate the younger three, to shepherd and direct them, to make decisions when careful contemplation and prayer is involved, but who often yields to any of the 3 “child parts” whenever one of them strongly takes over control.  Typically, though, the one in charge is either my 10 year old, mostly when I’m feeling fearful, or my 17 year old, when I’m feeling angry.  In happier moments, my 2 year old may come out, but it’s equally likely that my responsible adult is in the driver’s seat then, too.  There obviously can be mixtures of more than one of the parts, and it can often be very difficult to know “on the fly” which personality segment is actually front and center at any given moment.

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The problem is that I am typically not in a good, mentally healthy state of mind unless the responsible adult part of me is leading the way.  And if you are anything like me, most of the time I am not very mindful of what I am feeling or thinking on the inside.  I tend not to be very aware of times when one of my “children within” is in charge.  Those times are, of course, when the choices I make can most easily get off track, and can end up either hurting others or myself, or creating havoc that I will then have to later try to clean up.

So, how could I find a way to listen to the child parts inside me, and in so doing learn to more quickly and easily identify what is going on inside my mind at any given time?

One day, and I still don’t remember how or why, an image of a campfire came into my mind, and it was simply one of those “AHA!” moments that just make you smile or even laugh out loud!  I suddenly saw myself, in my mind, with my little 2 year old, the 10 year old, the 17 year old, and the responsible adult parts of me, all sitting around a quiet and peaceful campfire, out in the woods, where I felt completely safe and trusting, and I just knew that this was something that would work for me.

I began to practice sitting around that campfire, and at first I found that my “adult” part would not act responsibly at all.  He would, in fact, start going around the ring and telling the others what they must be feeling and thinking, and then he would tell all of them exactly how they were going to approach certain difficult situations, and certain people in my life.  It was not good, and I got nothing out of it.  It was somewhat frustrating, but I still remember that one day the thought (sent from my Creator, I believe) came into my mind that this is not the way campfires are done.  The campfire is best done the way that Native American tribes would conduct their “Council Fires”.  In those events the first persons to speak (after the singing and dancing and eating were concluded) would be the younger braves, followed by the middle-aged tribesmen, and the last to speak, after having heard and reflected upon all that the others had first contributed, would be the tribal chieftain, the eldest and wisest among them.

I decided to try this method out, and found that it was very helpful for me.  In fact, I have never found any other way of mindfulness or meditation that has taught me nearly as much as I have learned by following the campfire method.  I will try to illustrate how it works for me, and perhaps you might decide to try it out yourself.

First, I picture all of my “parts” sitting around a campfire.  To help the child parts feel most at ease I imagine that the fire is in a very safe area (i.e., no wild animals around), and that the temperature is very comfortable.  I picture the time as being just after sunset, as the image above would be, at the end of a cloudless day.  I imagine a fragrant smell, as the fire would be built from, say, hickory wood, and that there is an occasional hiss or crack from the fire, but it isn’t too noisy and doesn’t send sparks flying out at you.   I imagine that there are comfortable blankets around that we can drape over ourselves if we get chilled, or fearful.  I might even imagine a pot of coffee or hot chocolate nearby …

… in case it turns out to be a long and thirsty council meeting!

The bottom line is, for me it’s all about setting up an intimate meeting between the important portions of my own personality, for the main purpose of really hearing what these parts have to say to me;  what they have to teach me.  I feel comfortable with the imagery of the campfire scene, so this works very well for me.  For others, it might be a coffee shop, or their back porch, or riding in a car along quiet country roads, or simply sitting around the kitchen table.   I just believe strongly that it is often crucial to really know what’s going on inside us, especially when we’re feeling sad, afraid, anxious, angry, resentful, bored, frustrated, and sometimes, even when we’re feeling really happy or joyful.  If you are like me, these are important times in our lives, and for many of us, we have a hard time really getting in touch with our feelings and our self-talk in those times.  When we don’t pause to listen to ourselves, we can often make choices that we’ll later regret.

One thing that I have added to my setting as the years have gone on is that I also picture Jesus sitting among us.  Most often, He remains silent throughout the council, but He is there, most often very pleased to be there, very accepting and understanding of all of “us” (the children parts and me), especially when the truth is allowed to be spoken and felt without fear.

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So, say for example there is someone in my family with whom I have been really struggling to get along.  And say that I realize I have said something to this person that I’m now regretting, knowing that I was maybe too quick to anger, and I know I need to work my way through it.  I will have all my children and my adult gather in my mind around the fire, to sort things out.  I will typically go from youngest to eldest, allowing each part to talk about how they feel about this other person, and then often there will be “open floor” discussion after each part has had his initial say.

The way it usually goes is that my 2 year old will smile and laugh about how much he likes this other person, and will go through several features of the other person that he loves, or is very curious about.   Then the 10 year old will talk about how much he has been trying to get the other person to like him, feeling a strong need to maybe do more for this person, trying hard to avoid making that person mad or upset.  But, then the 17 year old will talk about the reasons why that person cannot be fully trusted, how and why he believes they have mistreated us, and will argue for backing off, for isolating ourselves from that person in order to be safe from harm.  Alternatively, if he feels I’ve been wronged, he may suggest ways to get back at the other, to “prove our case”, so to speak.  This may then go back and forth until it is time for my responsible adult part to thoughtfully and respectfully summarize all that has been said.  He then may call up various foundational truths, principles upon which I want my choices and my lifestyle to be based.

At some point, it will become fairly clear to me what ought to be the path forward.  I will either see in what ways I may have wronged or disrespected the other person, or where my own boundaries have become blurred, or perhaps where I have disrespected myself in some way and need to bolster that.  In most cases the main thing that I can change and which should be changed (recall the Serenity Prayer?) is my own attitude toward the other person.  I will realize that he or she, too, has a child within who has to struggle with hurt, fears, frustrations, and anxiety just as I do.  I will realize that God has freely given grace to me, and I ought to be compassionate and truthful in giving “grace” to the other person, too.

As I do these things, as I reflectively listen and then process these inner realities, most of the time I come away having a much greater sense of peace and clarity about it.  I leave the campfire feeling good, usually smiling, as I know that now I have nothing to fear, that all will be well.  It usually ends “good”, and all my parts feel better, like these folks …

… and these …

I hope that if and when you are faced with a struggle, or with anger, or fear or anxiety, over a particular situation or a particular person in your life, you will consider having your own “tribal council” around either a campfire of your own, or another similar safe place for you.  I believe you’ll find it very helpful, and will only make it easier in each moment to be more aware of your own present-moment state of mental health.

Take care, and happy trails to you!

Craig Meek, M.D.


Like a Rock! Well, maybe …

“If you hear that someone is speaking ill of you, instead of trying to defend yourself you should say: ‘He obviously does not know me very well, since there are so many other faults he could have mentioned.’”

Epictetus, ancient Greek “Stoic” philosopher

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“Against criticism a man can neither protest nor defend himself; he must act in spite of it, and then it will gradually yield to him.”

Johann Wolfgang von Goethe, German poet, playwright, novelist.

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“Merely through the constant need to ward off, one can become weak enough to be unable to defend oneself any longer.”

Friedrich Nietzsche, German philosopher

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“‘No’ is a complete sentence.”

Anne Lamott

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“Lord, defend me from my friends; I can account for my enemies”

Charles D’Hericault, author

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Once again, we see here an improbable belfry.  And yes, this IS a belfry (the tower to the far left of the photo).  This bell tower stands at one corner of a large castle in Salzburg, Austria.  The castle is known as the “Hohensalzburg Fortress“, and was built originally in the 11th century A.D., completed in the year 1077.  Later it was enlarged 3 times, in the 12th, 15th, and 17th centuries.  Its base stands nearly 400 feet above the town of Salzburg below.  Here is another picture of it:

As you can see here, the castle and its belfry stand WAY the heck on up there!  This is clearly a fortress meant for defensive purposes, and for that purpose it was apparently very well designed.  NO army that ever came against this castle defeated it, and there were quite a few who tried.

I would guess that, of all the things one could say or write about any castle, the fact that it was undefeated in its entire history would be one of the greatest.  Any belfry, as well as the bats and/or the shrink who inhabited it, would be very proud to be a part of that!  Well, maybe …

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Almost everyone knows what it’s like to have other people criticize them, mistreat them, accuse them of things they have not done, attack them in any number of ways.  And almost everyone also knows what it’s like, upon learning of such attacks, to instantly want to jump to defend themselves, and sometimes to attack back.  The sad thing is that after having suffered harm after harm, attack after attack, criticism after criticism, we all learn not to trust others; not our families, not our coworkers, not our friends,in some cases not even our very best friends.

And what is the eventual byproduct of not trusting almost anyone?  We end up living continually in a defensive posture.  The question is, though, is living in a defensive mode consistent with good mental health?

Recall our discussion about mental health from a few weeks ago?  My stance was that the Serenity Prayer written by Reinhold Niebuhr serves as one of the best models of good mental health we have.  Here it is again:

“God, give us grace to accept with serenity the things that cannot be changed,
courage to change the things which should be changed,
and the wisdom to distinguish the one from the other.
Living one day at a time,enjoying one moment at a time,
Accepting hardship as a pathway to peace;
Taking, as Jesus did, this sinful world as it is, not as I would have it;
Trusting that You will make all things right, if I surrender to Your will,
So that I may be reasonably happy in this life, and supremely happy with You forever in the next.
Amen.”

The picture painted by this prayer depicts one who is NOT constantly on the defensive.  The person who lives out the prayer is one who has an open heart and open hands as she or he approaches each new day, each encounter within that day.  This person accepts that the world IS and will be sinful, and yet still “enjoys” each moment, one at a time.  This person expects hardship, perhaps even expecting that part of that hardship will be the onslaught of others who hate or dislike, who desire to prop themselves up by taking this person down a notch or two.  This person trusts in God to make all things right, not necessarily instantly, but in God’s own timing, and only provided that this person is surrendered to God’s will.

In contrast, a person playing life defensively will be always on guard, always watchful for the next attempt by someone evil to break through his or her outer walls, so that he or she can counterattack and repel this coldhearted dog!  There is seldom room for enjoyment of life, except for those rare and fleeting moments when you can celebrate having successfully defended yourself, your reputation, your turf, etc., against yet another attack.  There is never an allowance that life is somehow meant to be difficult, never an allowance that people WILL be unloving no matter how well defended we are, never an acknowledgement that in spite of the hatred and unhealthy competition out there in the world that we are still called to be loving.

Did you happen to read the quote from Nietzsche above?  Although I part company with Nietzsche on his views on faith in God, his insight here, if accepted, will set another bat free from our belfries:  When someone lives constantly on the defensive, fending off attack after attack after attack, it eventually wears this person down.  It weakens us, and robs us of time in our lives we cannot get back.

So am I advocating allowing others to constantly run over us, to abuse us, mistreat us, never to fight back?  Well, someone infinitely wiser than I once did advocate just such a thing:

“You have heard that it was said, ‘An eye for an eye, and a tooth for a tooth.’  But I say to you, do not resist an evildoer.  If someone strikes you on the right cheek, turn to him the other also;  and if someone wants to sue you and take your coat, give him your cloak as well … I say to you, love your enemies, and pray for those who persecute you, so that you may be children of your Father in heaven.”

Matthew 6: 38-40, 44-45

However, I also believe that Jesus was in favor of being careful, of having healthy boundaries, of being smart about things, of not doing anything that would open ourselves up to justified prosecution, and to avoid needless harm:

“I am sending you out as sheep into the midst of wolves.  So be wise as serpents, yet innocent as doves.”

Matthew 10:16

This can be a very difficult balancing beam to walk, indeed.  Difficult, though nowhere near impossible.

First of all, the attitude we take into each day again becomes key.  We will have good, healthy boundaries, knowing and expecting that others will do things, either deliberately or incidentally, that will make life more difficult for us.  As Anne Lamott pointed out above, we can say “No” for ourselves, and not have to explain further.  We can, as a couple of the other quotes above instruct, go about our business as the serenity prayer calls us to, regardless of whether others try to criticize or do us harm.  But, we are careful not to do anything to directly bring criticism on our heads, or harm to those whom we care for and are responsible to defend.

In terms of dealing with unfair things that come our way, I am reminded of the TV show, Kung Fu, from my adolescence.  I always loved the character Caine, portrayed by David Carradine, as he traveled the old west in search of his long-lost half-brother.  However, he repeatedly, because of his spiritual training in a Shaolin monastery in his boyhood homeland of China, finds himself stepping in to defend various people being unfairly treated, oppressed, or harmed, when the odds were long against them.  The thing is, though, that Caine never took the offensive, and really was not defending himself, either, when “fighting”.  Rather, his opponents always were the ones on the offensive, and Caine would merely use their anger and unrighteous energy to their demise.  Every time they would come at him, he would merely feign and dodge, calmly tossing them on by as they lunged at him again and again.  Very little energy was used up; always he maintained his own boundaries, and never harmed anyone beyond what it took for the other to simply stop trying to fight.  It serves as a wonderful picture of the balancing act we’re calling ourselves to here.  The reed that bends with the wind (the ‘wind’ being those who would strike us on one cheek, or sue to take our coat), allowing the wind to flow on by, but does not break.  The reed maintains its foothold, its drive to love others and to stand for good and compassion always.

I am not inhuman.  I know what it is to want to fight back.  There have been a few instances just in the last few weeks in my place of work in which certain persons have mistreated others unjustly, and it makes my blood boil thinking about those things.  If and when there is an appropriate way, I will gladly stand in the breech and call for justice.  But, until then it would not be healthy, and I’m afraid my true motivation would simply be to see the “oppressor” suffer, rather than to see a wrong righted.  Until then I want to be the one we talked about last week, the one encouraging those who are hurting.  I want to be the one who encourages them and myself to “live well”, and to leave all else to God’s good and faithful hands.

Craig Meek, M.D.

Unbreaking the Circle

“It is really rather foolish to so often feel we have to say something brilliant and enlightening to someone who is suffering. Job makes it clear that simple companionship is what suffering people often crave – not a course in philosophy.”

Kathryn Lindskoog, author and lecturer, Leadership magazine – 1985 “What Do You Say to Job?”

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“Not allowing a person who has experienced a great loss to walk alone is the greatest act of love that heals.”

Pesach Krauss, Why Me?

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“If there were no suffering, would there be compassion? If there were no discipline and hardship, would we ever learn patience and endurance? Construct a universe with no trouble in it and immediately you banish some of the finest qualities in the world.”

James Stewart

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“It is one of the most beautiful compensations of this life that no man can sincerely help another without helping himself.”

Ralph Waldo Emerson

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“Everybody can be great, because anybody can serve, you don’t have to have a college degree to serve. You don’t have to make your subject and your verb agree to serve. You don’t have to know about Plato and Aristotle to serve. You don’t have to know Einstein’s theory of relativity to serve. You don’t have to know the second law of thermodynamics in physics to serve. You only need a heart full of grace. A soul generated by love. ”

Martin Luther King, Jr.

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“On the street I saw a small girl cold and shivering in a thin dress, with little hope of a decent meal. I became angry and said to God, ‘Why did you permit this? Why don’t you do something about it?’ For a while God said nothing. That night He replied quite suddenly, ‘I certainly did do something about it, I made you.'”

Unknown

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“In whatever God does in the course of our lives, he gives us, through the experience, some power to help others.”

Elisabeth Elliot

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“At the center of the universe is a loving heart that continues to beat and that wants the best for every person. Anything we can do to help foster the intellect and spirit and emotional growth of our fellow human beings, that is our job.

Those of us who have this particular vision must continue against all odds. Life is for service.”

Fred Rogers

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“When we are certain that the way to accomplish our own wishes is to help others, we have no regrets.”

Sakyong Mipham

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“I needed clothes, and you clothed me.  I was sick and you came to see me.  I was in prison and you came to visit me …

And the King shall answer and say, ‘Truly I say to you, whatever you did for one of the least of these brothers and sisters of mine, you also did for me.'”

Matthew 25: 36 and 40
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The belfry pictured above is not associated with a church.  It stands, as you can see, in the midst of a cemetery.  This particular cemetery is in County Carlow, Ireland, near the village of Rathanna.

Again, we turn to our imagination and see what it might tell us about this little belfry, and the bell hanging in it.  When would the bell be rung, and why?  I would guess they would ring the bell either before or after a funeral or interment, or perhaps on certain special days when folks nearby would memorialize those laid to rest in that particular cemetery.  Why?  My thought would be that the ringing of the bell would signal a call to the living, to honor and lend aid to those who have suffered loss.  Hearing the bell ringing, knowing where the belfry stands, would thus, just as a church bell ringing on a Sunday morning serves as a call to sinners to come and worship, in this case call anyone available to come and give support to the family and friends of whomever has just passed away.

When you think about it in these terms, it’s really a wonderful idea, to put a bell tower in a graveyard!  I could also see where mounting belfries to the tops of hospitals, homeless shelters, and maybe even jails would also be a great innovation!  Anything that would call us out of our normal day to day routine, alerting us that some fellow human is suffering and in need of help, comfort, support, or our simple respectful presence, would thus be of high value.

Have you read some of the quotes above?   Perhaps you’ve got a pretty good idea of where I’m going with this post.

The idea actually came to me this morning as I was waiting for my grandson Jacob to awaken.  I was reading a psychiatric journal and came across an article summarizing several published research studies.  One of them caught my eye:  Researchers actually completed a study which showed, through “Functional MRI” evidence obtained while people provided physical contact support of others who were receiving electrical shocks, that giving this kind of support was very helpful to the “supporters”.  It was helpful in several ways:  1) It showed greater activity in the ventral striatum, a part of the brain which has long been known to be one of the main “reward centers” of the brain;  2) The MRIs also showed high activation in the septal region of the brain, another “pleasure center”;  3) As a result of the septal region activity, this also lowered activity in both sides of the amygdala, which registers pain and triggers fear reactions.   The study compared people who would sit beside and hold the arm of the person receiving the shocks, versus others who would sit across the table from them and simply squeeze a rubber “stress ball”.  The ball-squeezers received none of the benefits listed above.   (Inagaki TK and Eisenberger NI.  “Neural correlates of giving support to a loved one.”  Psychosomatic Medicine;  2011 Nov. 9;)

Therefore, this study affirms that when people are present with and hold others who are suffering, there are both internal rewards and a lessening of the fear and anxiety the person giving that support might otherwise be feeling.   This is remarkable!  Not only will we feel better when we give direct care and support to those who are going through pain or loss, but we will have less fearfulness and anxiety.  It should also be noted that it has long been established that frequent reductions in amygdala “fear-inducing” activity is associated with living longer.  Thus, being a “people-helper” can help you feel better, feel more at peace, and live a longer life.

When you remind yourself that God designed us this way, it is no wonder that, in my view, we were put on this earth primarily to help one another.  Bad things such as pain, suffering, and loss happen in life primarily to teach us to attend to those who suffer, so that they can later help us when we suffer.  When you then add in this new data that reaching out and lending our presence, time, hugs, and a listening ear to sufferers and strugglers, actually IS its own reward, it lets loose one more bat from the belfry of our mind … the one that falsely tells us that we won’t know what to say or do, or that the cost will be too high, or we’ll just be “in the way”, or an annoyance.  Being there for others in their time of need WILL help them, and it will help us.

Not that we need to be driven by selfish motives … May it never be!  We’re only seeing, though, that our Creator knew that for us to help to “unbreak the circle” while still here on earth would be a very helpful thing for us.  It’s just another reason to rejoice in the amazing symmetry of God’s world, of life, and of the power we have to do good by serving others!

So let’s celebrate and lend our aid!

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“Bridge Over Troubled Water”  (Paul Simon)

“When you’re weary, feeling small.  When tears are in your eyes I will dry them all.
I’m on your side, when times get rough and friends just can’t be found;  Like a bridge over troubled water, I will lay me down;  Like a bridge over troubled water, I will lay me down.

When you’re down and out, when you’re on the street, when evening falls so hard, I will comfort you.
I’ll take your part, when darkness comes, and pain is all around, like a bridge over troubled water, I will lay me down;  Like a bridge over troubled water, I will lay me down.

Sail on Silver Girl;  Sail on by.  Your time has come to shine.  All your dreams are on their way.
See how they shine.  If you need a friend, I’m sailing right behind.  Like a bridge over troubled water, I will ease your mind;  Like a bridge over troubled water I will ease your mind.”

Thanks!

Craig Meek, M.D.

OK, let’s have some fun!

Now this is a glorious picture!  Just look at these bats madly rushing out of this church’s belfry!  What a fantastic shrink must have just moved into the belfry to do some bat-ousting!!!  Got ’em all out of there immediately!  I’ll bet all of that leftover guano smells PRETTY bad, though …

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A linguistics professor was lecturing his class one day.

“In English”, he said, “A double negative forms a positive.  In some languages, though, such as Russian, a double negative is still a negative.  However, there is no language wherein a double positive can form a negative.”

A loud voice from the back of the room piped up, “Yeah, right!”

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Now these young ladies are doing the world a HUGE favor by holding up the leaning Tower of Pisa in Italy!  Just like the young boy who still, to the best of my knowledge, has one of his fingers plugging that little hole in the dike, holding back the sea from drowning Holland, these two heroines will be sacrificing their lives for a while, at least until some others volunteer to take their places.  Let’s all give it up for servants of the world like these young people!

By the way, did you know that the leaning Tower of Pisa is actually a free-standing bell tower?  That’s right!  It serves as the bell tower for the Cathedral of Pisa, pictured above to the left of the tower.  So this tower is actually a leaning belfry!!!  And I thought bats were a problem!

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Newlyweds …

Husband:  Sweetheart, am I the only man you’ve ever loved?

Wife:  Of course you are, dear.  But why do all of you men keep asking me the same silly question?!?

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For all of us Doomsday Count-downers:


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And now for some more belfry humor:

After Quasimodo‘s death, Bishop Thomas of the cathedral of Notre Dame sent word through the streets of Paris that a new bell ringer was needed. The bishop decided that he would conduct the interviews personally and went up into the belfry to begin the screening process.

After observing while several applicants demonstrated their skills, he decided to call it a day.

Just then a lone, armless man approached him and announced that he was there to apply for the bell ringer’s job.

Bishop Thomas was incredulous. “You have no arms!”

”No matter,” said the man, “observe!” He then began striking the bells with his face, producing a beautiful melody on the carillon. The bishop listened in astonishment, convinced that he had finally found a suitable replacement for Quasimodo. Suddenly, while rushing forward to strike a bell, the armless man tripped and plunged headlong out of the belfry window to his death in the street below.

The stunned bishop immediately rushed down the stairways. When he reached the street, a crowd had gathered around the fallen figure, drawn by the beautiful music they had heard only moments before. As they silently parted to let the bishop through, one of them asked, “Bishop, who was this man?”

“I don’t know his name,” the bishop sadly replied, “but his face rings a bell.”

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Have a great day, and an even better week!  And please, try to do something good this week that you’ve been meaning to do for a while.  It will help your self-esteem, and that alone will make the world a better place!

Craig Meek, M.D.

On Self-Esteem …

Believe it or not, this is actually a belfry.  It’s a, uhhh … “belfry on the side”, so to speak.   This church is known as “The Church of San Martin Caballero”, and is located in a little village along the old Camino Real road in the coffee-growing region of Veracruz, Mexico.    Not exactly sure what happened here, but I would imagine that this little bell “tower” was added on sometime after the church had been built.

We’re left to use our imagination, as this church was built in 1776 (for some reason, that year rings a bell for me …), and there are no records, oral or written, that exist that might explain this odd, sideways belfry!   However, several clues really lead me to believe the belfry was added after the church was originally finished.

First, the stone used to support the tower is different from the stone used in the original wall of the church.  Second, if you look at the front facade of the church

 you see a completely different look than what is seen from the little belfry.  Even the roof tiles don’t really match those of the rest of the building.

Why is any of this important?  Well, probably none of it is important, but I think there may be a lesson for us about self-esteem.  Thus, we’ll just think about it for a while and as the days and weeks go by maybe we’ll come up with an answer.

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So, what exactly is “self-esteem”?

When I look up the definition for “esteem”, I see “regard” and “value”, both noun and verb.  When you tag on the “self” prefix, I would thus conclude this is the quality or amount (positive or negative) of value we attribute to ourselves, or if a verb, the positive or negative value we assign to ourselves as we think about ourselves and our place or importance in the world.

We hear so often that our culture has a self-esteem crisis.  I believe it.   If you’ll harken back to our discussion about depression, perhaps the greatest contributor to depression (recall that depression is the 4th leading cause of disability in the WORLD!) from our own internal stuff (non-biological) is poor self-esteem.  If I believe I am not worth very much, am not very competent, am ugly, am dumb, am hated by God, or perhaps already condemned, my attitude and my choices will reflect that view.  I will tend to hold a very pessimistic view of life and my chances for having a good one.  I will not hold much hope for things turning around.  And, if by some chance things begin to go right for me, I’ll be momentarily glad … until I remember that I’m certain to “blow it” sooner or later.   It makes for a very grim, cloudy, grey world.

How does a poor self-esteem happen?  In my view, the kinds of unhealthy competition that our society so readily fosters, with adults being so caught up in their own emotional struggles that they can’t figure out that it’s long overdue to change the messages we give little children, is the primary cause.  All of us remember the subtle but powerful beliefs we absorbed as kids.  Some were very young when they came.  Most of us were relatively healthy until we got to early adolescence (Middle School!!!).  A few lucky ones were in high school or college before they had it beaten into them that they were really not very competent, attractive, popular, or smart all along.  Regardless, our “chew ’em up and spit ’em out!” culture got to almost all of us.  From cutest baby contests to gold stars at day care to Christmas plays to spelling bees to who got picked first (or last!) for kickball to who sat alone at lunch every day to who had their lunch money stolen time and again to who always had their name misspelled, mispronounced, or worse, mocked in caricatures.   All of these and a thousand other little competitions all combined to tell us exactly who we were, who we are, and how high or low a value we hold in society, in life.  Even worse, some of us had our “value” beaten into or out of us by angry parents, stepparents, or other adults.  If we happened to be one of the very large portion of kids who also inherited a physiology that made us very anxious and nervous in many social situations (read, “school”), well, life was and has been a very difficult river to navigate.  No wonder, when all is said and done, that so many, many of us choose to numb that life with alcohol and drugs, and that we’ve had so many Judy Garlands, Norma Jean Mortensons (aka Marilyn Monroe), Janis Joplins, Jimi Hendrixes, Kurt Cobains, Michael Jacksons, Amy Winehouses, Heath Ledgers, Whitney Houstons.  So incredibly sad.

Is there any hope?  I believe there is … but as usual, it is an individual thing to improve it.  So how do you do that?

Improving self-esteem has been the subject of many, many books, magazine and journal articles, radio shows, documentaries, etc.  Many!  I really think many of us have at least one bat that is fluttering around in our belfry screeching all the wrong things about improving our own self-esteem!  Almost all of the stuff I’ve seen about building a healthy self-esteem is just so much crap!  Sorry, but to affirm every little thing that little Susie or little Johnny does will NOT have a positive impact on their self-esteem later on in life.  In fact, I’m not sure we as parents or adults can “hug”, “applaud”, or “affirm” our kids’ self-esteem enough to make a real difference.  We certainly can hurt their self-esteem if we don’t do those things!  But, ultimately the main jobs of parents, teachers, coaches, and adult role models of all flavors is to make sure kids are safe, that they know right from wrong, that they know where boundaries are and that there ARE consequences for crossing them.  Then, as they enter adolescence and gain the capability to understand why things are right and wrong, safe and unsafe, that we’re there to explain things, including the shades of gray, and that we’re there to listen to their thoughts and ideas, their struggles and breakthroughs.

Given good boundaries, safety, and enough of food and shelter, in a world that can be trusted, all of us were able to, and still are able to, give ourselves good, healthy, positive self-esteem.  How?  Well, it won’t come through others patting us on the back 5,000 times and telling us how great and how valued we are.  That’s all well and good, but ultimately where truth veers away from all the pop psychology out there is in the following, and this is very important, so listen up:  

I AM THE ONLY PERSON ON THE EARTH WHO CAN IMPROVE MY SELF-ESTEEM!!!

Did you get that?  Hope so.  Life, through the cooperation of many other people, has given us all the message that we just aren’t worth very much.  The reverse message must come from ourselves.  Reading or reciting written affirmations might help a little, but it won’t get us over the hump.  Real change in our self-esteem follows the “Missouri Rule”.  Our self-esteem says to us, “Show me.”  Plain and simple.  Prove to me that you are competent; that you can truly accomplish something.  And then it simply stands and waits.  It doesn’t give up, it doesn’t get impatient, but it doesn’t give us any “gimme’s”, either.  There is no other way around it … we must step up and do something good, something positive, to get the needle on our self-esteem meter to budge.

And what kinds of things are we talking about?  Really, doing just about anything can move that needle, so long as whatever we’re doing is healthy, important, makes a difference in the world, or makes a positive difference in us.  The way I put it to my patients is this:  making any real progress toward any kind of goal that is truly yours!  This is what makes for a better self-esteem!  So, anything from brushing our teeth more consistently, to eating  a little less, to walking a few times a week, to calling a relative we’ve been meaning to, to going to bed earlier, to studying a bit instead of playing an extra 15 minutes on a video game, to washing the dishes instead of leaving them “for tomorrow” for the 8th day in a row.  Anything can work, so long as afterward we know we’ve done something that is toward the good side of the ledger.  Doing things for ourselves can also help, if we typically do only for others.  Recharging our own batteries could be something we have long neglected because we told ourselves all along we weren’t worth it.

You know, this leads me to another truth:  We humans don’t make good hypocrites.  Oh, now don’t misunderstand me here!   We all can be hypocritical at times!  But one part or the other of us will be lying.  We either won’t really believe in the value we say we believe in, or our actions won’t truly reflect what we believe.  But we can’t say one thing and do another and believe them both!!!  Never happened.  Now what I mean here is, I try to get myself and many folks with whom I work to give themselves a voice.  To speak up for themselves.  Why?  Because if they do often enough, the value in which they hold themselves will HAVE to increase.  If you speak up for yourself, even though you don’t think you’re worth it, or you think you’ll offend someone, or put someone out and they’ll dislike you more, and you keep on doing so, sooner or later you’ll either begin to feel that you ARE worth speaking up for, or you’ll quit speaking up.  The two cannot co-exist.  And my belief and hope is that we all, whenever we are legitimately being unfairly treated, or are right about our views or our needs but they aren’t being attended to, will keep on speaking up for ourselves and not give up, EVEN if we have great doubts about ourselves or our voice.  If we do, I’m confident the amount and the way we esteem ourselves will inevitably grow!  It must.  And it will!

I urge you to try it out.  Treat yourself as important (not any more important than anyone else, but no less so), and your beliefs about yourself will have no choice but to improve.   And even if you have no belfry, and everyone else around you does, you won’t feel the need to build one, especially if all you can do is build a cheap one on the side!

Until next time!

Craig Meek, M.D.