What is a belfry, anyway?

It’s been a long time since I last posted an entry here.  A number of things have been percolating inside my head during that time, but the brewing process keeps getting interrupted … Not really “writer’s block”, as I don’t consider myself a ‘writer’, and I haven’t really been ‘blocked’.  In any case, here are some current thoughts …

**********

??????

Let’s consider a question:  What is a belfry?

By this I mean, what is the ‘essential nature’ of a bell tower?  What is its essence?  What is it that makes a belfry a belfry, and how is a belfry different from other tall or rooftop structures such as towers, domes, parapets, cupolas, etc.?

The true nature of bell towers is, undoubtedly, a subject upon which many people spend hours and hours meditating, so this is likely not a novel question for you all.  Of course, the obvious characteristic that sets belfries apart from other similar structures is the presence of a bell, as none of those other listed architectural features typically have bells hanging within.  But is there more to the answer than simply the bell?

Bell_Diagram

As a shrink who likes to, from time to time, think of myself as dwelling within a belfry, how would I describe the nature of a belfry?  First, I think of the walls of the belfry.  A belfry cannot exist without walls … else there would be nothing to support the roof and rafters, from which to hang the bell!  And all belfries’ walls must have openings, in the form of windows or louvered shutters, through which emanates the sound of the bells when they are being rung.  Wouldn’t be worth much as a bell tower if you couldn’t hear the bells!

2011-08-03_11_09_55

The walls are placed atop either a tower or the roof of a building, usually a church, sometimes a municipal building or courthouse.  A belfry therefore sits in an elevated position.  Then, obviously, I think of the roof of the bell tower, including its rafters, from which hangs the bell, or bells.  Most belfries would also have some kind of a floor, a set of stairs by which to access the tower, a rope with which to pull the bell(s) back and forth, and probably some bats hanging from the ceiling!

Bell_Ringers02

All of the features highlighted above are characteristic of bell towers.  They all, together, are belfries.  But, once again as we come full circle, the one thing that differentiates a belfry from every other tower around is the presence of the bell itself.  Without the bell, you cannot call it a belfry.  I think we can all agree on this point.  Again, though, back to the original questions, can we say that the bell IS the essential nature of a belfry?  Or, is the essence of a belfry better defined by both the bell AND the rest of the total structure?  If you leave out, or take away, any single part, would it still be a “belfry”?  To me, this is interesting to ponder …

**********

About three months ago I came across a quote by famous British author C.S. Lewis (of The Chronicles of Narnia fame) which has triggered a lot of reflection for me.  The quote reads:

“You don’t have a soul.  You are a soul.  You have a body.”

Lewis’ premise is that we as human beings are first and foremost spiritual beings.  That our true, original, core essence is “soul”, a spiritual entity, and that our bodies, along with our brains and our minds, are layers of “housing” that clothe our soul, and allow it to interact with the physical, visible world and the people and things in it.  At first glance, I can’t say that I disagree with Lewis, but I can say that I don’t fully understand this idea, or know how to think about it in clear terms, let alone discuss it using our limited language.

Of course, his thesis, and this entire discussion I’m about to enter into, are based entirely on a view of “truth” that is rooted in a belief, or faith, that there does exist a spiritual world which underlies our entire human experience.  I am not intelligent enough to formulate a testable, scientific hypothesis regarding the existence of a spiritual realm.  And if someone were to lay out such a(n) hypothesis, how could an experiment be designed to test it out?

Lewis himself, in his book Mere Christianity, bypassed scientific experimentation, and instead appealed to logical and philosophical arguments for the existence of God and soul.  He pointed out in significant detail how the basic moral value that all known races, tribes, and cultures seem to have in common – the seemingly innate belief that we must treat fellow humans and the world around us with care, respect, compassion, and fairness – proves that a single, common Mind must have designed and created it all; that such consistency running through all of human history, with all of the widespread migrations people have made, into every corner of the planet, through hundreds of generations, over thousands upon thousands of years, “proves” that all of us come from and possess the same “moral genetics”, rooted in and descended from that common Designer/Creator Mind.  And since we have yet to locate that Creator anywhere in the physical universe, it must be of a “spiritual” domain that remains invisible and intangible to our biological senses.

In contrast to that line of thought, there is a view of life based on the notion that all there is, both within ourselves and “out there”, is the physical, tangible, measureable world.  Other than conceptual notions such as emotions or dreams or values or thoughts, nothing exists unless it can be touched, seen, weighed, or measured.  All that is came into being in unknown ways, through random events over billions of uncountable years, for no real purpose, and will continue evolving, or devolving, as we all hurtle through space until some unforeseen and “random” event leads to the destruction of our sun or our planet … who knows?  The only important value in this view of life then becomes the need to ensure our species’, or our nation’s, or our race’s, or our family’s, or our own individual, survival.  Everything else becomes subservient to that value.

However, this belief system (and yes, it is as much a matter of belief, or faith, as the view espoused by Lewis) cannot explain the remarkable consistency of moral values across almost all known cultures down through human history.  Even within violent and warlike tribes and cultural groups, the rule of being good to one another is central and maintained, and acts of unfairness frowned upon or sanctioned.

When those, often referred to as “humanists”, who hold this view try to explain the central moral value noted above – the rule of fairness and kindness (or, “justice and mercy”, as the book of Micah calls it), they do so in some variation of the following:  humans adopted this value because they learned that looking after one another and treating each other well helped to keep families, nomadic groups, or villages bonded together, and thus this value was maintained solely as a means of protecting the species.  That sounds well and good on the surface, but this kind of world/life-view also possesses a central contradiction:  that is, when it becomes necessary to aggress against other humans in order for me or my group to survive, then it’s ok to set aside this basic value.   Huh?!!?  That doesn’t sound either moral or consistent to me.

To illustrate, if we consider the extreme atheistic beliefs undergirding the Marxist views of Stalin, Pol Pot, or Mao, among other genocidal autocrats, we see that such a reductionist view of life cannot help but to violate that consistent moral value of thousands of years of human life to which Lewis refers.  Such a view sees the killing of millions of humans as not only acceptable to them, but as necessary to help humans “move forward”.  It makes some humans more necessary than many, many others, and those less necessary as thus expendable.  This is terrible, ridiculous, and universally seen as evil (that is, in “violent violation” of all commonly held rules of decency) by anyone and everyone else, whether ‘theistic’, ‘atheistic’, or ‘agnostic’, even by those within those tyrants’ own cultural groups, even their own families.

Not only this, but as Lewis points out, those who study child development often comment on the fact that infants and toddlers, long before they could have “absorbed” the concept of fairness from their parents, seem to innately practice it, as well as expect it in return.  Little children are often noted to protest unfairness in interactions with peers before they can even speak.  How did we learn this notion at such a very young age, unless it were “wired-in” from conception?

Once again, therefore, the two ways to explain this consistency and primacy of central moral rule are either:  1)  A Creator Being brought all of our universe and our species into existence, and implanted within all of us a central moral genetic code which, when we are in selfish and self-centered mode we can choose to violate, but it still calls out to us (our “conscience”) from within;  or, 2)  Humans adopted this moral value as a means of survival, but will always set it aside when the TRUE central value – assuring my own survival and that of the few others I may care about – becomes threatened!  Which of course, renders it as not a moral value at all!  Merely window-dressing.  I believe it’s clear which view best accounts for the sociological and anthropological facts as we know them:  View #1.

I’m certain that I have not done justice to Lewis’ arguments, but they are compelling nonetheless.  I commend them to you, if you can locate the book referenced.

***********

Now, with all of that said, if you are willing to describe yourself as standing in the circle of folk who believe that there is a spiritual Creator Being who planned all that exists beforehand, and brought it all, directly and indirectly, into existence, then I invite you to look with me more deeply at the Lewis quote.

If we then accept that we are, in fact, as human beings at least partly spiritual beings, what if the real and true core of us IS that spiritual part?  What if Lewis is correct that we are really “SOUL”, and all the rest is or might be only temporary “machinery” for that soul to use?  Would this change your thinking about yourself, if you accepted this idea?  I think it is changing mine, though I’m still in the infancy stages, as I said above, of understanding it, or knowing what it means.

Next time, we’ll talk more about what this thing called a soul might be, and how it might, or even should, change how we view our lives.

Mental Health GPS

If I start outsourcing all my navigation to a little talking box in my car, I’m sort of screwed. I’m going to lose my car in the parking lot every single time.  ~ Ken Jennings

**********************

I love lighthouses.  I’ve never captained a ship, so I probably don’t love lighthouses as much as did the ships’ captains of the 18th and 19th centuries, whose lives and those of their crews depended very  literally on lighthouses, but nevertheless I’ve always admired those who built them and faithfully operated them.

Recently I began wondering if there were any belfries out there that doubled as lighthouses.  Turns out that there have been a few.

This little “bell tower”, which also doubled as a lighthouse, stood at the mouth of the Christiana River near Wilmington, Delaware in the late 1800s and early 1900s.  It no longer exists, but it must have been proud to do double duty while it lasted!

************************

Here is another interesting building!

This tower (the octagonal-shaped tower to the right of the picture) was built by the Romans just off the coast at Dover, England in the FIRST century, A.D.!  This means, obviously, that this tower is nearly 2,000 years old!  Amazing.  The Saxon-era church known as St. Mary-in-Castro, which stands alongside the tower, was built far later than the ancient lighthouse.  This tower was originally twice as tall as it is now.  Here it is about 4 stories high, but it originally was 8 stories tall, with the top level serving as both lookout and lighthouse, aiding Roman ships coming across from what is now France, or out of the Mediterranean Sea.  When the church was built, though, the top level shown here was turned into a belfry, and is still both a bell tower and has some lighthouse-type equipment for shining a light over the sea nearby!

*************************

This next picture is a little change of pace!

See any belfries in the picture?  At first glance, we don’t, but …

These two gentlemen, Gary Silcock and Phil Lewin, are employed at the famous British golf course and club known as The Belfry.  The Belfry has implemented in their golf carts a new GPS method of tracking where you are while playing a round on their links.  This picture doesn’t do it full justice, but the GPS monitor shown here can give you an exact reading of how far you are sitting from the cup at any point on a particular hole.  It also gives you distance to water hazards and sand traps, which for players who actually possess golf skill (a condition extremely foreign to this writer!) can be very helpful in deciding which club to use on a given shot, and how to play it.  For avid golfers, this is GPS’ potential applied in the finest way possible!

Almost every time I have looked up pictures of belfries, I can count on there being at least one of The Belfry golf course and its beautiful main building (part of which is shown above in the distance).  And now I’ve finally had the chance to use one of these pictures in a post!  I’m very pleased with myself!

************************

I own a small GPS monitor that was given to me a few years ago.  I don’t use it anymore, as it was a fairly low-tech model, and the software was not really updateable (is that a word?).   Plus, being the arrogant, egocentric fool that I often am, I tell myself that I don’t need one; that I can find my way around no matter what.  And, if I know I’m venturing somewhere unfamiliar in my car, I’ll look up directions ahead of time and print them!

Unfortunately, though, there are times when having one would really come in handy!  Especially if the device can steer you clear of bottlenecks in traffic, construction, or other pitfalls, or if it can give you others’ recommendations about the best places to eat, to visit, or in which to stay.  I don’t know … maybe one of these days I’ll invest in a better one and try using GPS again.

************************

Mental Health GPS!:

So, what do I mean by the title of this post, “Mental Health GPS”?

By using this made-up phrase I am referring to how one might find their way around the array of mental healthcare services that are currently available in our society.  And, by “our society” I’m afraid I’m only speaking of the way things are in the United States.  I simply have no knowledge of how mental health services are laid out and delivered in other nations.  Sorry about that.

I often am approached by friends, family, even co-workers, who have either difficulties themselves, or know someone who is in need of help, asking for my advice about where and with whom and how to find that help.  It is a big question, very important for people who really need quality services that they can afford, especially when most people really are very unaware of how mental health treatment is delivered nowadays.  Finding the right care in a timely fashion can be lifesaving in some cases, can make a huge difference for good in many other cases, yet for some odd reason our delivery system is not well-geared to making this search easy.

Let’s talk about it.

Where do most people start?  Where do they typically begin when they start to realize that something is going on that they either can’t snap out of (feeling empty, sad, tearful all the time, tired all the time, sleeping all the time, or even hopeless or suicidal), can’t seem to control (feeling nervous, anxious, fearful, shaky to the point it’s causing trouble in one’s work, school, or social life), isn’t going away over time (grief, anger problems, etc.), or is alarming and scary (hearing voices, panic attacks, feeling paranoid all the time)?  To whom do they turn when they realize they can’t stop drinking or smoking pot, or other drugs?

 

The Tallest Hurdle:

Of course, the main hurdle lies in actually deciding that you are going to try to get help.  Most people I know will avoid seeking help for long periods of time, until they simply can’t wait any longer, or a major crisis arises from which there seems no other option.

 

Where to Begin (Word of Mouth):

Your experience may be different, but most folks I’ve seen have started out by talking to a friend, or occasionally a family member.  Usually most people have known of someone who had mental illness problems and have been told – usually in whispered or gossipy tones – where or how that person tried to get help.  If the result seemed to be positive, then they will be very likely to seek out help from that same source, whether it fits or not.  We don’t like to waste our time or money, and if your cousin was depressed and went to see someone at ABC Counseling Services, and seemed to get worse after 4 or 5 visits, it’s going to be very unlikely that you will call ABC.  If, on the other hand, if your coworker, Dave, was thrown out of his girlfriend’s house because he was constantly losing his temper, and then he went to Dr. X, a family physician in town, was put on medicine, and now swears it has “worked miracles in his life”, it is highly likely you might be looking up the number for Dr. X tonight, whether you have the same problem as Dave or not.

In other words, the most powerful influence in where most people start is “word of mouth”.   And the better you know the person from whose mouth the ‘word’ is coming, the greater the influence.

 

Your Doc:

However, not everyone has heard about places to seek help, and so they start looking elsewhere.   A lot of people will go and see their personal or family doctor to talk about what’s going on, and in MOST cases that is a good place to begin.  Most doctors do take mental illness problems seriously, though they won’t all actually take some time to sit down across from you and ask a few questions, or really listen to what you need to say.  And, most doctors and nurse practitioners do want to help you, and avoid hurting you.  They do, most of the time, know their limitations.  If you go to see them about feeling sad or empty fairly often, most of the time for more than the last two weeks, they might feel comfortable prescribing a standard antidepressant at low to moderate doses, and have you come back in 3-4 weeks.  If you start feeling better, no problem, and they’ll keep the medicine going for a while, knowing you’ll eventually either quit taking it on your own, or you will together decide it’s been long enough and it’s time to stop the med.  And, if there aren’t any major issues going on that contributed to the mild depression, that’s perfectly fine.  Same thing if you’re having a good bit of anxiety in social situations, or you get very irritable right before your period, or if you’re having difficulty getting to sleep.

On the other hand, if you’re seriously thinking about suicide, or your marriage is falling apart, or you’re kicking the dog and yelling at your wife and kids all the time, or they try a couple of different medicines and things seem to be getting worse rather than better, then most doctors will tell you what you likely already know:  it’s time to see a mental health specialist of some sort.  And, for most people in my experience, this is not what they hoped to hear.  It is extremely frightening for most people who have never been exposed to therapists or psychiatrists to think about going to see one, knowing you will have to, if you want to get better, open up some things you typically guard with great secrecy, especially from strangers or casual acquaintances.  But, if you trust your doctor enough, then it’s more likely that you’ll be able to overcome that fear and actually get in touch with whomever the doc suggests or, hopefully, recommends.

 

Yikes!  No doctor!:

Some folks, though, don’t have a primary care doctor.  If they also have no “word of mouth” references, then where do they turn?  There still are Yellow Pages out there, even in the well-established internet search engine age, and many people will begin looking there.  Or, they might sit down and search on the internet for mental health services in their area.  The problems here are that Yellow Pages, either printed or on the internet, typically have no reviews associated with them, and the listings and/or ads only tell you what the service was willing to pay to tell you.  That is, some clinics, counselors, and doctors aren’t even listed, and many others are only a name, an address (maybe), and a phone number.  A few will run ads listing various problems they can help with, or perhaps some of the types of therapy they are trained in and can offer.  Beyond this, you’re going to have to call them to learn anything else.

There are a few forums around on the internet in which various therapists and/or psychiatrists or psychiatric nurse practitioners are rated or reviewed by clients.  Unfortunately, here I really can’t offer much of an opinion.  In my experience the people who take the time to speak up about their therapist or prescriber are either feeling disrespected or ‘cheated’ by the (lack of) care they received, or they are subconsciously magnifying their good feelings about that care to a level that is simply too good to be true.  Not only this, but as you can imagine, with the wide variety of problems and issues that people come in with, one person’s experience with treatment for Post-Traumatic Stress Disorder may be completely irrelevant to whether you would have the same results if you go in to the same provider for relationship counseling, or for diagnosis and treatment of what may be ADHD.

 

The Insurance Nightmare:

Then, of course, once you begin making calls to providers the question inevitably arises, how much is this going to cost me, and how am I going to pay for it?  For those who have health insurance of some sort, the first place they might have to call is their insurance, and in many cases you might have to then call a “behavioral health management” company who contracts with your insurance to screen subscribers and then refer them to certain providers.  In the end, they’re going to send you to the place that will cost THEM the least payout money, and there is very little you can do about it, unless you decide to pay out of pocket for your care.  It’s kind of a mess, to put it mildly.

These days, for good or for ill, a LOT of therapists and psychiatrists are foregoing any kind of insurance affiliations at all, and asking people to simply pay cash for every visit.  Usually there are set fees:  so much for an initial evaluation, so much for follow-up visits, so much for 45-60 minute therapy visits, so much for testing, etc.   They will often file claims for you with your insurance, AFTER you pay them up front, and then anything you get back from your insurance is a kind of rebate.    This change is due to the fact that insurance companies have become systemically corrupt about their obligations.  They simply will not pay doctors, therapists, hospitals, and pharmacies until months or even years have gone by, and that is only in the cases in which they have not denied authorizing the services in the first place (sometimes, insurances have been known to wait until after the services have been given and THEN deny payment).  Insurance exists to help cover the cost of “medically necessary” treatments, but only THEY decide what is medically necessary in many cases.   These kind of practices will likely only get worse until finally some kind of scandal will erupt into the mainstream media, and then the entire industry will hopefully be forced to either change, or be eliminated.  The latter is not bloody likely.

 

Yikes!  No insurance!:

But, what if someone out there doesn’t have any health insurance?  Well, if this person has the resources (i.e., money) they can pay a provider as noted above, paying a cash fee at each visit, or alternatively work out an installment payment agreement, or perhaps in some cases negotiating a reduced fee based on what the person can actually afford to pay.

For others, that’s where companies like the one I work for come in.  I am employed by a community mental health center (CMHC).  This is a type of private but non-profit agency, most of which began in the mid-1960s after Congress passed its famous (among mental health practitioners, at least) “deinstitutionalization” legislation.  Basically, foresightful persons realized that with the advent of better medications for illnesses such as Schizophrenia, and better services to provide care for persons with mental retardation and brain injuries, we did not need to keep these folks cordoned off in state psychiatric hospitals, “asylums”, or nursing homes for the rest of their lives.  Community services, such as psychiatric treatment and case management, as well as residential and day treatment services, were thus put together based on huge grants of money so that every rural county and every urban neighborhood would have a CMHC nearby.  These agencies were organized to take care of these folks coming out of long-term care institutions, but also to provide mental health care for anyone who needed it, regardless of their ability to pay.  Most of the persons we now serve are already disabled in some way, and are covered, at least in part, by some form of Medicare or Medicaid insurance.  But, many who come to us have no insurance, and we typically see them on either a “sliding scale” fee arrangement, or in some cases for no fee at all.  States reimburse CMHCs for these indigent care services in the form of general fund grants or block grants.

Unfortunately, these grants and other forms of public funding are expensive.  Over the decades, federal assistance has gradually diminished to aid states, and thus many states have devised various managed care arrangements, or have even opened up bidding to “for profit” companies to come in and run their public mental health delivery systems.  The results have consistently been disastrous, unless you happen to be an accountant in that state’s budget office, in which case the results might seem more positive.  But, there are various ways to do balance sheets.  When you add in the costs of hospitalization of people who “crashed” due to the lack of service availability  in their community, and various other indirect costs stemming from the lack of affordable or free care, that bottom line might look a little different.

Over time, CMHCs have grown quite a bit from their original mission.  We still provide care for many who have severe and chronic mental illness, as well as any number of services for those with intellectual disabilities, to keep them living in the community.  However, now we also provide psychotherapy services for almost any form of mental health issue.  We provide therapy, school-based, clinic-based, and home-based, for children and adolescents, summer day programs for kids, and comprehensive case management for families when both children and parents have significant mental illnesses.  We provide, in many cases, assessment and treatment for substance abuse problems.  Some CMHCs contract with their localities to run DUI classes and monitoring.  Some provide methadone or Suboxone maintenance clinics for persons with heroin or pain pill adictions.  Some CMHCs have crisis stabilization units, where children or adults can go and stay for 1-7 days when they are in crisis but don’t need the extra security of a locked hospital unit.

Many CMHCs, however, faced with rising costs of employing all the people necessary to provide these broad services, and seeing declining help from their state governments, have now cut way back on what they will provide.  Many have had to close their doors altogether, and a number of areas in the U.S. now have no community psychiatric center around whatsoever.  In many other places the CMHC will only have therapists and psychiatric prescribers, with perhaps a few case managers, and often there is a dearth of all three.  There can be very long waits to get an initial appointment with a therapist, and even longer to see a prescriber, if you see one at all.

In urban areas there are often free clinics where indigent and homeless persons can find some help.  These are typically staffed by volunteers, working either in their spare time, or having already retired from active employment themselves.  These clinics are often lifesaving Godsends for some people for whom it would not take much to see them jumping off of bridges, or stepping out in front of a bus, due to the lack of help and medicine.

Beyond this, many people seek help from their pastors or priests, and some rare larger churches actually employ pastoral counselors on their staff.  Unfortunately, while the potential is high for this mode of service to be extremely helpful, as for so many people their mental illness issues greatly impact their spiritual health, and vice versa, this potential is seldom fulfilled.  The sad reality is that at present seeking help from clergy is often ineffective, misleading, or disillusioning.  Someone who is trusted and who is comfortable discussing the interplay between one’s faith, or struggles with faith, one’s concept and relationship with God, and one’s mental health or mental illness, and is a good listener, on a church staff would be an incredible gift to those parishioners of such a church.   There is a lot more I have to say to those clergy and others in ministry, to try to help them understand mental illness better, and how to better help those struggling with it, but that’s material for another post, another day.  Suffice to say that at present there is still a tremendous amount of misunderstanding and misinformation among the clergy I’m familiar with.  Hopefully we can help see that potential noted above turned around for the better!

 

So what’s going to happen to me?

Once someone locates a provider to whom they’ve either been referred, or whom they’ve heard good things about, or have identified as the one that seems most likely to be the right one for them, or else is the only provider around, the next thing to do is to make a phone call.  Typically, the best person to make the call is the person seeking help!  It might be very hard to pick up that phone or to dial the number and press ‘Send’.  But, hopefully, the courage will be there and it will happen.  Before you call, prepare yourself to ask some questions, and to give a little information about yourself and the type of problems you’re having.  If I were seeking help, I would want to know what the process is.  Who will I see first?  Will I continue to see that person, or will I be “assigned” to someone else after the initial assessment?  Will I see a doctor?  Do I need to see a doctor, or a therapist, or both?  How much will it cost me?  If I have insurance, do they accept my insurance?  Where are they located, and how do I get there?  (yeah, I know, wouldn’t be a problem if I would actually use my GPS!!)  Are they open in the evenings, or on Saturdays?  There may be other questions you can think of that might be important to you.  The person who answers your call, typically an office support person, will usually be able to answer most of the questions noted above.  If you decide during the call that you want to move forward, they should be able to schedule an appointment for you, and let you know what things you need to bring with you to that first visit.  Also, based on what you tell them, they should be able to tell you if it sounds like they will be able to offer help for the kind of problems you’re dealing with, or not.  If not, hopefully the person will be able to give you an idea or two of other providers or services in that area that might be better equipped.

In most cases, if we’re talking about “outpatient” help, in the U.S. your first appointment will likely be with a “therapist”.  Typically this is either a clinical social worker, a clinical psychologist, or a trained counselor of some type.  In some private practices, in which a psychiatrist or a group of psychiatrists, and perhaps nurse practitioners, have no therapists on their staff, then you may see a doctor from the first visit.  In other cases, especially if you have been referred by another doctor, you might see a doctor first, and then if deemed appropriate referred to a therapist as well.

The purpose of the initial appointment is to “assess” you and your problem.  There will be a number and variety of questions asked of you, usually most of them verbal and face to face, but in some practices a lot of the questions will be paper and pen.  Either way, questions will be asked about the nature of the problem(s) you’re dealing with and what or how you have tried to manage it so far, and the results of such efforts.  You’ll be asked about any past treatment you’ve had for similar problems, or any other mental health issues.  There will likely be questions asked about your social background, how life was for you growing up, any major life events or traumas that occurred, your educational and vocational history, as well as family and relationship experiences.  You’ll be asked about drinking and drug use history, with most focus being on current or recent past use/abuse.  You’ll be asked about which blood relatives might have had psychiatric problems or treatment.  There should be some questions about medical history, and any medicines you’re taking for any reason.  They should focus particularly on any neurological conditions you may have had:  seizures, head injuries, etc.  Finally, you should be asked about what your own hopes, goals, or expectations for treatment might be.

In light of the above, it is always helpful to think ahead of time about some of the areas I’ve outlined here.  The better and more quickly you can give information, the more time you’ll have to really spell out the main problem that led to seeking help.  And, while most of us who work in the field expect that people will not be ready to discuss very intimate details of their lives, their pain, their fears and insecurities on the first visit with a complete stranger, it is always best to be as honest as you can be.  As I have often told people I see, I don’t get upset about not being told the truth … I understand the drive to thought well of, and to hide when we’re fearful.  However, if I’m given an overall picture of what is really someone’s “pretend” life, or “pretend” problems, then the treatment I can offer will also be “pretend”, too.  Not intentionally, of course, but pretend nonetheless.

 

The Closing Discussion:

At the conclusion of this visit you should get some feedback.  You should expect to be told what the therapist or doctor thinks is going on, and possibly a “diagnosis”.  However, please be wary about placing too much emphasis on a diagnosis or label, especially in the psychiatric field.

The way I think about things for my patients is in terms of:

1) symptoms – things one experiences that are or could be “treatable”, maybe with medical treatments such as medicine;  This could be things such as depressed mood, panic attacks, difficulty falling asleep, hearing voices, or a tendency to have manic mood episodes at times.

2) issues – patterns, conflicts, social tendencies, longstanding resentments and fears, etc., that a person can learn to manage or resolve better, typically through learning better insights, strategies, self-talk, communication techniques, etc.;

3) prevention – that is, (and this is where knowing the diagnosis is or can be important) what near or distant future problems or recurrences or relapses is this person most at risk of, and how can we work together to prevent those problems on an ongoing basis.  In diagnoses such as recurring Depression, Bipolar Disorder, Schizophrenia, Panic Disorder, or Substance addictions, prevention is huge in the long-term treatment of these conditions.

At any rate, the person who assesses you intially should be able to give you a picture of where they think you should go from there.  If you clearly or very possibly could benefit from medical treatment, if it’s a therapist seeing you they should get you scheduled for an appointment with a prescriber (usually one in their own practice or clinic, and if not, someone to whom they frequently refer and with whom they are comfortable, given your presenting problems).  If it’s a prescriber you’re seeing, then they will talk about possible medication options.

They also should give you a synopsis of how they see your “issues” and how therapy might be able to help.  They could give you a few ideas of ways that you might begin to make helpful changes in your lifestyle or the way you address frustrations or conflict in your relationships, or setting better boundaries for yourself at work, for example.  However, in many cases they might wait on this kind of discussion until the next appointment(s), when the focus will begin narrowing to the main problems at hand, and less on getting a broad picture of you as a person.

Something just doesn’t seem right!

How will you know if the therapist or doctor you’re seeing is “right” for you?  This is a tough issue, as sometimes, especially if you go into therapy, this person may be helping you see things in your life that are critically important, but which you won’t be very comfortable thinking or talking about.  She or he may begin discussing defenses of yours, or tendencies you have, or patterns of self-talk you do, that will need to be changed or gradually eliminated, and this may be very frightening to you.  So you have to be careful about wishes to “try someone new”, when sticking with the caregiver you’re seeing is exactly what you need to do!

In mental health, as with almost any kind of situation in which we turn to a professional for help, there are three traits of such a professional that are most important in getting the help you want and need:

1)  Knowledge base of the kind of problem you have;  This refers to how well-educated this professional is about the nature of your particular problem and the best ways to treat it.  In therapists, for example, there is one form of therapy that has been shown again and again to be very highly effective for conditions such as depression, obsessive-compulsive disorder, and certain types of anxiety:  Cognitive-Behavioral Therapy.  Unfortunately, relatively few therapists really have been trained in how to do this (CBT) well.  They have all heard about it, and been given some basic information about how it is done and how it works.  But that is a far different thing than to have been really trained in the method.  In prescribers, knowledge must include a good understanding of how to differentiate between things that should be medicated and those that should not.  It should also include a good working knowledge of the various medicines one might prescribe, the risks of each, and possible interactions and other effects with other medicines and general medical conditions.

2)  Experience;  As with anything difficult, helping people with mental illness is something for which there is no substitute for experience.  It takes time and doing it a lot to become adept and really effective.  Unfortunately, again, in this field there are many people out there who have no choice but to start out their therapy, especially, with counselors who just finished a Master’s degree program, often with precious little actual experience doing therapy under supervision.  This can be a rough thing when you need help quickly and it might be too much to expect novices to be smooth and comfortable.

3)  The right fit!  I’ve listed this one third, but in reality it is THE most important factor, and is the one that often makes or breaks the “result”.  This refers to whether or not you can develop trust for the professional.  Does he or she seem to really understand what you’re dealing with, what your experience has been like?  Do they convey a sense that they can empathize with you?  Does her or his personality fit with yours?  Do they have good listening skills?  Do they seem confident that they can help you help yourself with the problem?  Do they seem warm, or cold?  Do they make eye contact with you?  Are they condescending, or seem to smirk when you talk about certain struggles you have?  If you come to them and sincerely tell them that a certain medicine is, or has been, really working well for you, does she or he dismiss this out of hand, and either want to take you off the medicine or eliminate it as a possible option automatically?  Do they make suggestions, give recommendations, or give ‘directives’?  If you are in crisis, but you tell the caregiver that you are deathly afraid of being sent to a hospital, do they work with you to find alternative ways to ensure your safety until the crisis passes, or do they seem unwilling to consider anything but hospitalization?  These are the kinds of things that can make a huge difference in both the short run and the longer term.

If you decide that you simply cannot work well with a particular professional, you have the right to ask for a change.  However, be careful, as you never know when such a request will be taken personally, and things can quickly become very tense in their office or clinic.  We in the field of mental health care, and in medicine in particular, have been trained to NOT take such requests or statements personally, realizing that such statements may be very healthy for the patient to make, and that not all helper-client relationships are going to be a good fit either way.  The caregiver may, and really should, ask to discuss the reasons for your change of provider request, just to help both you and they to see where there could be misunderstandings, false expectations, or perhaps areas in which the professional might improve the way they listen and interact.

The more difficult thing, though, is that people rarely want to hurt others’ feelings, and many recoil from asking  for a new provider for fear of making their current one “feel bad”, or “get mad”.  I understand.  I would feel the same.  But, it is your life, and if you need to see someone else, it is perfectly ok.  The sad thing is that, rather than asking for a referral to someone else, they will simply stop showing up for appointments, or stop setting up new ones.

************************

I hope this discussion will be helpful to you or to someone who asks you for advice or suggestions.  There is obviously far more to talk about that falls under the umbrella of “navigating the mental health waters.”   Knowing whether you’re getting “better”, how quickly or how much better you should expect to get, and whether the care you’re receiving is really the best treatment, not to mention talking about inpatient care, or about all of the auxiliary forms of treatment such as 12-Step groups, support groups, intensive outpatient treatment programs, and substance abuse rehab centers, are all fairly important discussions that are also both broad and deep.  Hopefully we can look at those in the future.

For now, though, I hope this has given you some direction, and some basic pointers of how to get off to a good start in treatment.  If you’ve seen any holes in what I’ve laid out, or have suggestions or questions, please feel free to leave a comment, and I’ll try to respond!

Craig Meek, M.D.

Food Fight!

“Eat to live, and not live to eat.”  ~ Benjamin Franklin

*********************

The title of this post might be a bit misleading …

When I say ‘food fight’, I am not referring to the raucous heydays of slapstick humor, ranging from the Three Stooges to Animal House to your very own high school cafeteria!

I’m talking about the internal fight over food that many, many of us fight almost constantly!

I’m talking about the fight between the wise part of our minds and the part of us that just wants to feel good!

I’m talking about the fight between the part of us that knows a grilled chicken salad drizzled with olive oil vinaigrette and a tall ice water, would be far better for us and our futures than a thick, juicy cheeseburger, heavy on the mayo, with a very large side of crinkle-cut fries liberally covered with salt and ketchup, and a chocolate milkshake to wash it down!

Now that, for a lot of people, is a heckuva fight, is it not?!?   (By the way, quickly, which would you choose, right at this moment?)  For other people, it may be other things … such as when it’s about 9 or 10 in the evening, and you’re feeling hungry, or you want a snack to accompany the TV show you’re watching, or the book you’re reading, or you’re just bored and need something to do, and putting food into our mouths is an interesting activity.  So, in those cases the fight can be about other possible choices.

For many of us, such fights are all-out wars!  And in far too many of these wars, we end up surrendering to the part of our mind that tells us which choice would be most pleasing to our taste buds, stomach, emotions, etc., … but at what price?

***********************

No ‘Shrink in the Belfry’ post would be complete without a picture of a belfry, and this is no different.  The pictures above are of a very interesting place.  It’s a restaurant called, “Beans in the Belfry”, and it’s located in and under the belfry of an old Methodist church in Brunswick, Maryland.  The church was built in 1910, but a number of years ago, after the railroad economy of Brunswick collapsed, the church basically folded.   A few years ago, a couple of enterprising folks bought the building and spruced it up, turning it into a coffee house and restaurant that features highly eclectic furnishings, a variety of live music, and reportedly good food.

Just goes to show that even belfries can be pleasing to the palate!

*********************

Let’s cut to the chase:

It is my opinion that in no other aspect of human life does falsehood play such a dominant role than in the way we eat.  And unfortunately, it causes huge fights.  As I have written in the past, one 0f my goals is to identify falsehoods by which many of us routinely make choices – let’s call each of these “bats”, living in the belfries of our minds – and to help us all cast them out.  So, where are we deceiving ourselves?

For one thing, we are almost all of us convinced that unless food tastes good, and we usually mean “REALLY” good, we don’t want to eat it.  Various types of vegetables and vegetable dishes fall often into the category of, well, “optional”, since the flavor might not be on our favorites list.  Somewhere along the line, our culture assimilated and accepted the idea that it’s ok to only eat food that one likes, and to discard the rest.  Which is one of the reasons why, I believe, TV shows about cooking have become so popular.  We all keep hoping that someday, somebody will invent a way to prepare spinach, turnips, asparagus, okra, and broccoli that will be super easy, but also super tasty.  So far, it hasn’t happened for a lot of us, so we keep tuning in to see what Paula, Guy, Rachael, Giada, Alton, Ina, and Bobby have for us, hoping and hoping and hoping and ….

Is this true?  Does food that is not only good for us, but in many ways essential for our overall health and well-being, have to be pleasing to our palates in all cases?  Is there perhaps a way to alter our mental approach to eating so that we find our pleasure in knowing we are taking good care of our bodies, regardless of how the food actually tastes?

Another lie that we have adopted as truth is that to be truly satisfied at the end of a meal is to feel full.  We have not truly dined unless our stomach is yelling up to our head that it is stretched far enough!

Unfortunately, nothing could be further from the truth.

We are convinced, most of us, that unless our stomachs and brains are telling us that we are absolutely full, we are not yet “done eating”.  It is my belief, despite the fact that I often fall victim to the very lie I have just laid out, that if we are hearing the message, “Hey!  Stop eating!  We’re stuffed down here!”, from our stomach, then we have already consumed FAR too much food.  I don’t know why our stomachs will hold a much larger quantity of food than we actually need, but they do.  We really don’t need all that much food to thrive, let alone survive.

Finally, one of the main reasons we eat is to “feel better”.  And, the sooner the better for most of us.  Ever wonder where the term, “comfort food” came from?  Ever feel the need for instant comfort?  Wonder why so many people have trouble with drugs, alcohol, sex, gambling, partying, and, yes, food?  The thing is, that we DO live in a highly stressful world.  Yes, it is true that we bring a ton of stress upon ourselves by believing certain lies about life.  We believe that a lot of very unimportant things (in the long run) are incredibly urgent, even crucial, to our existence and well-being, and it eats us up all the time.   When this happens we get into a big hurry to find relief … a momentary and immediate escape from the stress we live with.  What better escape than a pleasant one?  And what better pleasant escape than something that really feels good as we see it, smell it, bite into it, taste it, chew it, roll it around in our mouths, something really substantial, pleasing all of our senses, all of our taste buds, and then swallow, getting that satisfied feeling that words can’t really convey that we have taken “the good stuff” in.

Food really is, for many of us, a drug.

Totally legal.

All created by God.

But if we don’t follow the principles of truth, it will kill us.

***********************

How can we get a better hold on this concept of eating?

Well, first, I suggest that we all try to learn to forgive ourselves for whatever mistakes we have made, for believing whichever lies we might have believed, and for following the strong voice of our bodies so often.  Once again, we must remind ourselves that we are all fallen creatures, and that grace is the umbrella under which we live and breathe and have our being.

Secondly, remember in all things, at all times, that balance is the key, not extremism.  God DID give us all plants of the field, all fruit of the trees, all fish of the lakes and seas, and all beasts of the wood and fields for our sustenance AND enjoyment.  God also gave us eyes, taste buds, and nostrils, and betwixt the three of them we find exquisite sights and flavors in many foods … these are not things to be ashamed of.  These are things to be enjoyed!

However, remember again, balance … enjoy the viewing pleasure of food well-presented, enjoy the wonderful and enticing aromas, enjoy the delightful and manifold flavors and tastes and textures of many kinds of foods, but remember that we are eating primarily in order to sustain and nourish our bodies and brains for the many tasks they must perform in service to the Creator and to other children of God around us, and the many years in which we might serve.

So, all of that said, the third thing we must keep before us always is to remember that intelligent people are telling us all the time about the best ways to eat.  Listen to them, and try to find ways that:  1)  follow the “food pyramid” as closely as possible;  2)  keep within our individual budget;  3)  look, smell, and taste good;  and 4) without involving too much sugar, too many chemicals, too much white flour, too much fat, too late in the evening (remember, almost everything you eat within 3 hours of your normal bedtime, your body will believe that you don’t need it right away – which is largely true, so it will “save it for a rainy day”, and the way the body does this is to shunt it all into fat storage!), or too much volume (again, remember that the appropriate portion size for almost everything we eat is what fits in the cupped palm of our hand.  In other words, not a heckuva lot!   But, if you slow down, really savor every bite, and chew slowly and thoughtfully, it will seem so much more enjoyable and fulfilling.  I guarantee it!).

We’ve been fighting this food fight for years, most of us, and it’s really far past time for us to breathe deeply, remember that life is about LIFE and SERVICE, not about food, and that there are many healthier ways to get our stress relief “fix” besides chips and dip, huge bowls of ice cream, mounds of cookies, and other assorted indulgences.

And really, there is no deadline.   So, please, take your time.  Pick out one aspect of your eating that you will change first, build a new habit (takes a month of doing it daily, so the experts say), and then move on to something else.

So, make whichever choice you want to first:  smaller portion sizes, eating nothing within 3 hours of bedtime (you will NOT starve!), lower fat content,  eliminate white sugar/corn syrup/fructose/artificial sweeteners, less white flour/white rice, adding in one more serving of vegies and one more of fruit daily, chew more slowly and more times before swallowing … doesn’t matter which one.  Just do one at a time.  Then another.  And then another.  We CAN win this fight, but not if we get all hyped up about it and decide we’re going to “never eat another cookie as along as I live!”, or some such vow.

Be gentle with yourself, enjoy wholesome food, don’t make it your drug.

********************

One final word:

In social gatherings, I have often joked that I believe calories consumed during special social events are completely ignored by the body, and just excreted in the usual ways.  Obviously, that is not the truth (though it always sounds good!).

However, I do believe that we as humans do one another a favor when we give ourselves permission to eat things that ordinarily we would consider as too rich or too fattening, when it’s a “special event”.  But even here, we can be “mentally healthy” about it.  We can take a very small piece of cake, a thinner than usual slice of pie, eat one scoop of ice cream instead of 2 or 3, go easy on seconds, just be healthy and balanced.  After all, the central point of gathering is the human fellowship and support of one another, NOT the ingestion of good food or drink.  But if reasonable intake of good food helps lighten your heart, and in turn helps you really be there for others in either good times or bad, then so much the better.

A clean belfry is always a good thing, and healthy eating is not that difficult.  Let’s choose to love ourselves by picking one area to work on this coming month.  Let’s build a new, good habit!

Eat to live, and food fight won!

Craig Meek, M.D.

 

Loving ourselves …

You shall love your neighbor in the same way that you love yourself.  ~ Jesus, Matthew 22:39

*******************

I’ve been waiting to write this post for a long time.  The subject is extremely dear to me, and  is one about which I am very passionate.  In every setting in which I have ever worked, I have tried to encourage colleagues, patients, AND myself to put a higher priority on this theme.  I believe it is truly the linchpin that, if firmly set in place in our moment-by-moment choices and daily habits, could and would pull our lives forward into having great positive impacts on the little worlds around each of us.

This subject is:  loving ourselves.  Now, in this phrase I am first and foremost referring to the word ‘loving’ as a verb.  That is, I’m not so much speaking of the emotional, feelings side of love.  I’m talking about how we treat ourselves; the things we do, or not, to take care of ourselves, our lives, on a daily basis.

Do you see what I am saying here?  I am not saying that liking ourselves, or feeling deeply in love with ourselves, is the big key here.  Actually, if you are like the vast majority of people I know, suggesting that you ought to like yourself, or have strong, passionate feelings of love toward yourself, would at first be an appealing suggestion, but it would have very little chance of happening simply by us deciding that, yeah, hey!  I’m going to really like myself today!  For whatever reason, it just doesn’t seem to work that way.  We seem to, most of us, not really like ourselves much at all, in fact.  And just deciding to do so would fade very quickly as our longstanding feelings of shame, guilt, inferiority, unloveliness, and unlikeability would soon take over once again.

So, what I’m actually suggesting here is to do an end-run, a “flanking maneuver”, in military parlance, around our feelings about ourselves.  I’m saying, let’s forget how we feel about ourselves, and see if we can use our powers of reason to come up with enough motivation to take good care of ourselves anyway, in spite of not really liking ourselves.  Does that seem doable?  I hope so, because if you’re like me, it ain’t gonna happen if I wait for the good feelings to come first, or to stay!

Alcoholics Anonymous has many slogans, some of which have been very helpful to me after I had learned of them.  One of these is “Fake it ’til you make it!”  This refers to the fact that when a real alcoholic first enters into recovery, he or she finds that they have to start doing a lot of things that, a) they don’t like doing;  b) they are not used to doing;  and c) seem pretty downright silly!  Things such as attending meetings with people you don’t know very well, telling your story (the whole truth!) to strangers, or picking up the phone and calling your sponsor when you’re REALLY craving a drink, are not fun things to do for these folks!  But, as oldtimers who have built up a lot of serenity and strength of recovery will tell them, that’s okay, just “fake it ’til you make it.”  Actually, this again points up one of the great, but little known truths about us humans:  we don’t long keep doing things that we feel are useless or pointless, even though they are very worthwhile.  Sooner or later, one or the other will change.  We’ll either stop doing those things, or our feelings about them will change toward the positive.  And that’s what we’re talking about here.

I want us to look at ways to treat ourselves better, despite the fact that we might think it’s selfish, or that we’re not worth treating well, or that it won’t matter in the end ‘cuz WE don’t matter.  I really believe that if we do begin making healthier choices for ourselves, and KEEP doing this, that eventually we WILL start feeling good about ourselves.  We will start liking ourselves.  We will begin believing that we have a good purpose here on earth, and that our future will be successful in the ways it was meant to be!   And then, one day we’ll find that we have made it!  That our feelings match up with our choices!  That will be a great day.

*******************

Here are some quotes that I found helpful … hope you’ll agree:

To be beautiful means to be yourself. You don’t need to be accepted by others. You need to accept yourself.  ~ Thich Nhat Hanh

I have an everyday religion that works for me. Love yourself first, and everything else falls into line.  You really have to love yourself to get anything done in this world.  ~ Lucille Ball

He lives long that lives well, and time misspent is not lived, but lost.  ~ Thomas Fuller

Those who think they have not time for bodily exercise will sooner or later have to find time for illness.  ~ Edward Stanley

If I were given the opportunity to present a gift to the next generation, it would be the ability for each individual to learn to laugh at himself.  ~ Charles Schulz

Eat to live, and not live to eat.  ~ Benjamin Franklin

We are what we repeatedly do.  Excellence, then, is not a single act, but a habit.  ~ Aristotle

The day the child realizes that all adults are imperfect he becomes an adolescent; the day he forgives them, he becomes an adult; the day he forgives himself, he becomes wise.  ~ Aiden Nowlan

The important thing is not to stop questioning.  Curiosity has its own reason for existing.  ~ Albert Einstein

Our bodies are the gardens to which our wills are gardeners.  ~ William Shakespeare

If you aren’t good at loving yourself, you will have a difficult time loving anyone, since you’ll resent the time and energy you give another person that you aren’t even giving to yourself.  ~ Barbara De Angelis

To be yourself in a world that is constantly trying to make you something else is the greatest accomplishment.  ~ Ralph Waldo Emerson

Or do you not know that your body is a temple of the Holy Spirit who lives within you, whom you have received from God?  You are not your own, for you were bought with a very high price.  Therefore, honor your Creator with your body.  ~ I Corinthians 6:19-20

I see my body as an instrument, not as an ornament.  My body is not an object on display for pleasure or judgment.  It is a vehicle, equipped with legs that allow me to visit my favorite places; with arms that allow me to embrace the people I love.  It is my home; the bearer of my soul and the carrier of my spirit.  My body does not reflect my self-worth.  ~ Alanis Morissette

Plant your own garden and decorate your own soul, instead of waiting for someone to bring you flowers.  ~ Veronica A. Shoffstall

Self-love is not opposed to the love of other people. You cannot really love yourself and do yourself a favor without doing other people a favor, and vise versa.  ~ Dr. Karl Menninger

We are wont to condemn self-love; but what we really mean to condemn is contrary to self-love.  It is that mixture of selfishness and self-hate that permanently pursues us, that prevents us from loving others, and that really prohibits us from loving ourselves.  ~ Paul Valery

*******************

The picture below is of a small church known as St. Leonard’s Church, located in the town of Wixoe, Suffolk County, England.  It is said to be well cared for, and sits at the heart of the village.  The belfry dates from the 15th century, and as you can see, compared to so many of the pictures of belfries I have posted here on these pages, this is a very modest and yet self-assured bell tower.  Like the old belfry on the campus of Radford University, this one seems perfectly OK with who and what it is, what its job is, and does it very well.  And the people who love it so much don’t mind making the effort to take care of it, knowing that this care will pay great dividends, both in their lifetimes and in those of Wixoe citizens’ lives yet to come.  So far as I could find, there is no reference to any person or persons having their names engraved on plaques or other monuments in or around this church or bell tower:

*******************

Now here is another church with a bell tower, also described as very “well cared for”.  This is the  Church of St. Mary Magdalene, located in Sutton-in-Ashfield, which happens to be located in the county of Nottingham (ring any ‘bells’?) in England.  This church dates from the 12th century A.D.  It is very pretty, certainly.  The description also goes into great detail regarding the tidy (I am sure) sums that various members of the Sutton family paid to make sure this church and its bell tower were well cared for as time passed.  To make sure, their names are engraved on several plaques located in and around the church.  Do you think Walter, Gerard, Jordan, and William Sutton were more interested in the beauty of the church and its grounds, the clarity, tone, and volume of the belfry’s bells, or their own legacy, when they paid considerable sums to ensure that both the stones of the church as well as their names were well-preserved into posterity? As I said, though, this is a pretty church!

*******************

One of the things I most appreciate about the small town in which I live is the small, Christian liberal arts college located here.  They now call themselves a University (ahh, modern times!), but I still know who and what they are and were meant to be (a college!), and I appreciate them for whom they are.  This College (yes, I AM obstinate!) has a very nice bell tower that sits atop the administration building.

Every day, from 8 a.m. until 8 p.m., the bells in this belfry sound out the time every 15 minutes, playing the old Westminster Chimes theme.  In the spring and summer months, when in the afternoons and early evenings I am likely to be outdoors in my back yard, pulling weeds, or pruning trees or perennial shrubs or flowers, or relaxing on the swing, or just walking around admiring God’s marvelous handiwork, those chimes fill me with peace and quiet joy.  Just hearing them makes me feel as if there are still little parts of the world that remain secure and steadfast, just as they were SUPPOSED to be.  Occasionally, such as at noon or around 5:00 p.m., the carrillonneur (the person who plays the bells) will play a hymn, and this makes it even better, in my opinion.

And then I find myself appreciating and mentally thanking all of those persons who, a hundred or so years ago, advocated for the building of that belfry and the purchase of those bells, and the many other persons who have, over the decades, maintained that tower and the bells, as well as the ropes and chains from which they are suspended.  None of them did this for me.  They did it because it was right and good in their eyes.  They took the time and effort, and paid out the money, so that the present and the future of the college and the town in which it sits would be a little bit better because of the wonderful tone of those bells in that tower!  I strongly doubt that any of them has their name engraved on a bronze plaque over at that college (errr … University!).  As I said, I am very grateful.

*******************

Taking good care of ourselves is about just that:  taking … care … of … ourselves.   It is a mindset, a commitment, an attitude, and a set of practices that is very, very hard for us to introduce into our lives, and to build into habits.  It requires, for most of us, making changes in our lifestyle.  Remember, it does NOT require us to FEEL LIKE making changes.  And, it does not require us to feel “sick”, or that we’re “getting old”, or that there is something wrong with us in any way.

Similar to the contrast that we drew a few weeks ago between mental health and mental illness, good self-care does not imply the existence of some kind of disorder or illness, but neither does it imply the absence of such.  Self-care, caring for oneself – one’s body, mind, soul, time, talents, interests … everything that comprises each of us – is really the verbs that would comprise loving oneself, again, in the non-emotional sense we talked about above.

Many people have told me that they interpret Jesus’ quote from Matthew at the top of the page above to mean that since God knows that we are hopelessly selfish and “in love with ourselves”, we should use our ‘boundless, ego-centered love for self’ as the measuring stick by which we ought to boundlessly love others.  It was God “giving in” to our self-centered nature, knowing we would never stop loving ourselves, so He was just commanding us to give at least as much time and effort caring about others as we give ourselves!  Well, I am certainly no theologian, but this does not jive with what I know about God (who in my belief is, after all, all-knowing), and about us!  Not at all.

In my view, the commandment is indeed twofold.  We are instructed to love our neighbors AND to love ourselves.  And what did Jesus mean by the use of the word, ‘love’?  Did he mean the passionate, romantic feeling kind of love we often think of?  Apparently not, as the very next thing he said, in response to the question, “And who is my neighbor?”, was to describe a set of almost incredible (especially to the Jews who sat there listening) and selfless actions of a Samaritan (whom the Jews apparently despised) in caring for a Jewish man who had fallen prey to robbers who beat him and left him for dead.

Now, ’tis true that the main thrust of this command is to do just the same as the Samaritan for anyone whom we see in need around us, when we have the opportunity and ability to help.  But the command does, indeed, also refer to loving ourselves!  And, whether or not we believe Jesus is being somewhat resigned about our selfish natures, it is clear that he expects us to be looking after the needs of ourselves in the same mindful, compassionate, and selfless way.

As you might imagine, I work with a lot of people who are or have been very depressed.  I can tell you that in almost every case, most of these persons are the kind who would rather take care of others than to take care of themselves.  In many cases, shame and guilt drive them to try to please others by serving them all day long.  While there may be unhealthy beliefs at work underneath this “others-first” mindset, I really believe most of them are very unselfish.  When I talk with them about exercise, or speaking up for themselves, or eating in a healthy way, or resting when they are tired and are at their limit, or simply saying ‘no’, they almost invariably shrink away, as they believe this would be “selfish”.

On the surface, so it might seem.  And certainly, you could do some very good things for yourself FOR selfish motives and reasons!  In fact, “looking out for #1!” was an American national catchphrase through much of the 1980s and 90s!

But, as the Karl Menninger quote above describes, when we do ourselves a favor and take care of ourselves, such as going to bed at an early hour, we are really doing others a favor, as this makes us better people!  It helps us be better able to take care of them!  I discuss with people all the time how, if they can’t be with their lover or their spouse, or their children or grandchildren, or anyone else whom they care for, by taking good care of themselves now they will be the very best friend/lover/spouse/mother/father/grandparent, etc. they can possibly be when the time comes that they are reunited!  So whatever your motives are, Love-ing yourself is a good and kind thing to do.

********************

So, how do we get started?  Well, lots of ways.  But we’ll have to flesh this out over time.  I want to look with you at several different ways in which we can take better care of ourselves.  We will talk about exercise, about eating (and drinking!), about rest, about dressing and grooming, about taking care of our minds, about having fun, and about taking care of our souls and spirits!  Maybe even one or two things that will come up as the winds change!  So please stick around!

Let’s begin to think of our lives as if they are gardens, and we have just been hired to be the gardeners.  And as the bells chime out the hours from the belfry in the distance, we’ll work to make those gardens wonderful and beautiful for the “neighbors” we’re loving!

Craig Meek, M.D.

“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!!!!”

*************************

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!

***********************

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.

***********************

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.

**********************

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.

**********************

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.   🙂

***********************

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.

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.

********************

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.

********************

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.

*********************

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!

********************

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!

*************************

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.

***********************

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.

*************************

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.