speaking of daddy issues, I unabashedly omitted information from my dad, concerning the details of my graduation from nursing school. I was simultaneously applying mascara in the mirror, prepping for my night out. I escaped without permanent blindness or a flat-out lie. I told him it was some Thursday in May [true]. He seemed to sense that this was not the whole story, so I conceded that I wasn't sure of the times and stuff because the administration at my school is guiltier of procrastination than I am [also a true statement]. This conversation rattled me, so what do I do? Call my straight, platonic man-friend (SPMF). Super healthy!
I laid out the dilemma: I am graduating - a big life event! My father should be present if he so wishes. But, he has no money for transportation or a place to say. I do not have the funds to front him. In addition, there is the distinct possibility that he will have a "bad Parkinsonian day" once he gets here and be unable to attend anyhow. Some days, the meds are not enough; and he experiences "freezing" and anxiety. Some days, it's too much; and he experiences exaggerated or squirming movements called dyskinesia. Also, there's a small part of me that just doesn't want to deal with the drama.
SPMF laughed and said, "well, then. I think you have your answer. I think you just need someone to say, 'you are making the right decision. you are not a bad person for thinking the way you do.' Allow me to be that person... Also, I can't make it tonight. I'm not feeling well. I think I'm just gonna stay in and be sick."
In the midst of my dilemma and his supportiveness, I forgot all about asking him out. (how could I? I even okay'd the move with my Man-conscience!) I wished him well in his recovery and promised to make time to see him soon, when he is well. I made my way to TD Bank to withdraw some cash. Then I visited work to get a good cup of coffee in me before an evening of dancing. I had already flirted with the idea of a nap but lacked the time. Coffee was a must.
Even though I work there, the menu still gives me order anxiety. Plus, it doesn't help that my coworkers are lovable nuts. We distract/tease/insult one another constantly. In my indecision, I failed to notice SPMF enter the line until he poked my shoulder. I... what? I greeted him amiably; we talked a bit in line. I ordered a sadness pastry and a cup of coffee. He bought his typical biker mag and a large tea because he had "this terrible sinus thing." During this time, Man-conscience spotted me from his department and sent me a series of text messages.
"Oh.My.GOD."
"And you come HERE? Awesome."
totally unaware of the fact that Man-conscience was even working, I paid for and received my coffee. I turned eight shades of red, I'm sure. I told the staff I would return for my pastry and power-walked to his department. Moments before I was about to accost him, a customer swept between our locked gaze and asked for assistance. I turned on my heel and fled the department, to the tune of the buzzer going off for my baked good. I returned to line to retrieve it and explain a bit of the situation to Bestie and the other staff on the clock.
"Oh, no. Caitlyn! I thought you two were meeting here and then going together!"
"No, this is me being stood up and then accidentally catching my stander-up in a lie in public!"
I excused myself to go explain to Man-conscience. I thanked everyone and headed to the back of the store. SPMF and Man-conscience were talking! Grumbling to myself, I pretended to be interested in a display table, keeping most of my focus on the back of the store. I grew more and more irritated by the time lapse, but hey. SPMF hadn't visited in months -- of COURSE they had a lot to say to one another. And before I knew it, I was sucked into a vortex of conversation with a very loud coworker. SPMF approached us and squeezed into the conversation with the coworker's totally subtle comment, "You're cute. Who are you?"
Lord, may you strike me down dead. Right here. Please. The coworker was caught in the act of avoiding her allotted department and excused herself. SPMF and I were free to discuss school, graduation, his job, and other stuff we hadn't shared in a while. My coworker escaped the section and sneaked back to our conversation and essentially forced out SPMF out. once he was barely out of earshot, she suggests, "he's cute. Ask him out."
"I did. This is actually me being stood up."
She laughed heartily, taking an uncomfortably long period of time to realize that I was not kidding. She sobered up fast, and said, "Well, geez, Caitlyn. I just don't get it. You're pretty. What's wrong with you?"
"Hah, thanks. If I knew the answer to that question, I wouldn't have these problems."
I eventually explained my plight to Man-conscience [who provided the comment that would later become the title to this blog entry] and had a fabulous night out of dancing. but for now, I give up.
Friday, April 12, 2013
Thursday, April 11, 2013
thought digestion
Before beginning my community rotation down-Cape next week, our clinical group was together one last time to meet at Gosnold - a local organization that treats addiction as a chronic disease, instead of a series of character defects. Gosnold provides a continuum of services, from acute withdrawal care to community outreach programs designed to keep graduates of the detoxification program stay in a remission period, with abstinence as a goal. Today, we got a brief overview of their philosophies and the evidence they use to fuel their practice.
Most notably, our preceptor focused on emergent neurobiology that supports their thesis that addiction is an illness of a chronic sort, characterized by exacerbations and remissions. Addiction is believed to be the cause of a dysfunction of the mesolimbic-dopamine system, or the "pleasure center" of the brain. In times of pleasurable activity, naturally occurring opioids [you may have heard of endorphins or enkaphelins? those] are released, bind to mu receptors in this system, whose cells release dopamine which causes the "feel-good" feeling.
As with most body systems, this is a negative feedback system -- think of this process as a thermostat. You set the suitable threshold, and once the desired temperature has been reached, the system shuts off. But say you've set the thermostat to 68 before leaving for work and the outside temperature reaches 89. The heating system shuts down its production altogether. Say this heat wave continues all week. The heating system lies dormant. This, too, is true of dopamine-producing cells in the brain in the presence of exogenous opioids [mind-altering substances]. The cells are quieted because the threshold of dopamine has been reached, and if the use continues, the system is overridden and becomes dormant.
Dr. Nora Volkow describes the effects of mind-altering substances in the addicted brain. Mind altering substances affect both reward and motivation centers, and cognitive processes. Using overactivates the reward and motivation centers, which hijack the cognitive processing [logic/decision-making/etc.] center. So next time you look at an addict and think, "DEAR LORD, DO YOU NOT REALIZE THAT YOU ARE RUINING YOUR LIFE," remember that perhaps they do not. The need to normalize/supplement their brain chemistry becomes a compulsion impossible to overcome without multiple intervention strategies -- just as the compulsion to, say, wash hands thirty times before eating is impossible to ignore for the obsessive-compulsive without multiple intervention strategies. For more information on her and her peers' work, she writes a fabulous blog for drugabuse.gov.
I must say, the more I learn, the more these findings put my heart at rest. When the news broke that my father was an addict, I was all, "you love cocaine more than you love me and my brothers, so fuck you and your phone calls." But viewing this problem in the framework of a chronic illness, it really takes the pressure off me. Uhm, his brain is hijacked. He wasn't standing in the doorway of our apartment, weighing his options. His compulsion was driving his decision-making. I am not to blame. I am not less than a substance. I am just an innocent bystander that he hurt in the acute phase of his illness.
What I cannot decouple from my mind is addiction and firsts. I am the direct descendent of an addict, which means I have a four-times greater likelihood of developing an addiction of my own than the next guy. But, like... that shit doesn't appeal to me in the slightest. And much like eating snails, I cannot begin to understand why it is appealing to anyone. So, sure, I may possess the phenotype that predisposes me to such things, but if I never take the first step, I never contract the disease. SO WTF!!!!
In the case of my father, I know this is also not mine. This. is. not. mine. The disease, in all likelihood, was given wings long before I was born. And I just so happened to be present for his periods of remission and reactivation of symptoms. It's a damn shame. But you know what? We approached him. We offered him options. We provided support. But he would not accept the help we were willing to give. So if I want to reunite with the man I remember as my father from my childhood, he will have to come to the conclusion that he needs help and wants to change all on his own.
Can I be angry about decisions he made before I existed? Sure. Will my anger accomplish anything? Apparently not. Slowly but surely, I am letting go. I will love him in the best way I know how. And if he ever approaches me for help, I will not refuse -- as long as the interventions are evidence-based. But until such time, THIS. IS. NOT. MINE.
phew, that feels so good to say.
Most notably, our preceptor focused on emergent neurobiology that supports their thesis that addiction is an illness of a chronic sort, characterized by exacerbations and remissions. Addiction is believed to be the cause of a dysfunction of the mesolimbic-dopamine system, or the "pleasure center" of the brain. In times of pleasurable activity, naturally occurring opioids [you may have heard of endorphins or enkaphelins? those] are released, bind to mu receptors in this system, whose cells release dopamine which causes the "feel-good" feeling.
As with most body systems, this is a negative feedback system -- think of this process as a thermostat. You set the suitable threshold, and once the desired temperature has been reached, the system shuts off. But say you've set the thermostat to 68 before leaving for work and the outside temperature reaches 89. The heating system shuts down its production altogether. Say this heat wave continues all week. The heating system lies dormant. This, too, is true of dopamine-producing cells in the brain in the presence of exogenous opioids [mind-altering substances]. The cells are quieted because the threshold of dopamine has been reached, and if the use continues, the system is overridden and becomes dormant.
Dr. Nora Volkow describes the effects of mind-altering substances in the addicted brain. Mind altering substances affect both reward and motivation centers, and cognitive processes. Using overactivates the reward and motivation centers, which hijack the cognitive processing [logic/decision-making/etc.] center. So next time you look at an addict and think, "DEAR LORD, DO YOU NOT REALIZE THAT YOU ARE RUINING YOUR LIFE," remember that perhaps they do not. The need to normalize/supplement their brain chemistry becomes a compulsion impossible to overcome without multiple intervention strategies -- just as the compulsion to, say, wash hands thirty times before eating is impossible to ignore for the obsessive-compulsive without multiple intervention strategies. For more information on her and her peers' work, she writes a fabulous blog for drugabuse.gov.
I must say, the more I learn, the more these findings put my heart at rest. When the news broke that my father was an addict, I was all, "you love cocaine more than you love me and my brothers, so fuck you and your phone calls." But viewing this problem in the framework of a chronic illness, it really takes the pressure off me. Uhm, his brain is hijacked. He wasn't standing in the doorway of our apartment, weighing his options. His compulsion was driving his decision-making. I am not to blame. I am not less than a substance. I am just an innocent bystander that he hurt in the acute phase of his illness.
What I cannot decouple from my mind is addiction and firsts. I am the direct descendent of an addict, which means I have a four-times greater likelihood of developing an addiction of my own than the next guy. But, like... that shit doesn't appeal to me in the slightest. And much like eating snails, I cannot begin to understand why it is appealing to anyone. So, sure, I may possess the phenotype that predisposes me to such things, but if I never take the first step, I never contract the disease. SO WTF!!!!
In the case of my father, I know this is also not mine. This. is. not. mine. The disease, in all likelihood, was given wings long before I was born. And I just so happened to be present for his periods of remission and reactivation of symptoms. It's a damn shame. But you know what? We approached him. We offered him options. We provided support. But he would not accept the help we were willing to give. So if I want to reunite with the man I remember as my father from my childhood, he will have to come to the conclusion that he needs help and wants to change all on his own.
Can I be angry about decisions he made before I existed? Sure. Will my anger accomplish anything? Apparently not. Slowly but surely, I am letting go. I will love him in the best way I know how. And if he ever approaches me for help, I will not refuse -- as long as the interventions are evidence-based. But until such time, THIS. IS. NOT. MINE.
phew, that feels so good to say.
Thursday, April 4, 2013
vulnerability is not weakness and other disputed truths.
hi, all. I must apologize for falling off the face of the earth. I grew accustomed to writing about my personal growth (and completely foolish moments) on here, but for the last few weeks, I have been graded on these thoughts and feelings during my mental health rotations. I also just realized I stopped blogging right after I explored my thoughts and feelings on depression. LULZORZ, sorry if I scared the crap out of some of you. I have no suicidal ideations. In fact, I am completing crisis training for the Samaritans Group. Check out their story here.
So here is a quick synopsis of things I have gleaned from my time in mental health, which I will call "Practicing What I Test Well In." [or perhaps, "How Did You Not Know That, Caitlyn? 'Cause It's More Difficult Than It Sounds, Rude."]
-- like the title of this blog posts suggests, vulnerability is not weakness. possessing the courage to reveal yourself to another is a strength that not everyone is capable of displaying, no matter how evolved the individual claims to be. vulnerability and bravery will not always pay in dividends. you may be disappointed, even heartbroken, but this should not be a deterrent.
-- primitive instincts are still very much alive. territoriality scares the shit out of me. I typically need three weeks to feel at ease with a person/place/thing, a luxury not afforded to an ADN student. my unease was always there, I just never had to journal about it and confront it before.
-- fake it till you feel it. the mind is a great and powerful force, capable of hurting and healing itself. I read an article online about the phenomenon in which acting in a certain way causes brain chemistry to adapt to your state of being. for example, the other night, I went in with the mindset that no matter how paralyzed by fear I was, I would force myself to walk in confidence. and you know what? it worked. I didn't stick to the strict script we are taught in lecture. I cursed myself for initiating a handshake, but all the client wanted to know was that I cared about them. and all that self-doubt and worrying and other silliness just didn't matter because all I need is empathy. I don't need a task to hide behind, like I did in Med-Surg. I just need to walk in heart-first, and I'll be fine.
And if I may share another story with you, I'll include no identifying information, just that information which I feel is essential for everyone to realize. A client who could easily say he or she had "The American Dream" in his or her pocket was admitted to the unit. On paper, everything was great: a happy marriage, a high-power position, a beautiful family, home ownership in the suburbs, good friends, etc. And yet, one day, the client booked an appointment with the family primary care physician and expressed feelings of depression. During the conversation, the PCP explained that in order to diagnose the client with depression, the client would have to exhibit at least five signs. The client demonstrated eleven. The client entered a crisis intervention program, and 4/5 of the way through the program, the insurance company pulled the plug on coverage. Finding no closure, the client returned home. About two weeks later, the client was home babysitting while the client's partner was out with friends and kissed the children for "what felt like the last time." When the partner returned home, the client shared these feelings with the partner, who called in backup to ensure the client's safety until a plan could be set in motion.
I feel this story is important for everyone to hear because the client's physician and family modeled excellent strategies to deal with depression. The partner did not take the client's feelings personally; instead, the partner reached out to their shared social support system in time of need and got the client the help the client needed. The physician did not dismiss or overlook the concerns of the client. Some terrifying fraction like one third of all people who attempt and succeed suicide see their primary care physicians within a week of the attempt. The number of individuals grows even larger, to something like three-fourths,who see their primary cares within a month of suicide. Every day, those with burdened hearts cry out for help and go entirely unnoticed. As a future nurse and citizen of humanity, I seek to keep an open mind and open heart to make fewer of those voices slip through our fingers.
AND IF YOU READ NO OTHER PART OF THIS BLOG ENTRY, LET IT BE THIS:
Sometimes, depression isn’t “caused.” It lies. It grows. It destroys. But mostly, depression just is. Outside things, other people, and accolades cannot make you happy. You have to make you happy. And sometimes, your brain chemistry makes it impossible to do so without drug therapy. Hearing this story – I think – made me really understand that mental illness is not a choice. It is not a product of your environment. It is not an unfortunate side effect of your life, decisions, and circumstances. It is a chemical process. Can depression be influenced by these things? Absolutely. But are these factors always a mean to the same end? no.
So walk in love, equipped with this knowledge, as I plan to do.
and if by some crazy happenstance, dear client, you find my blog, I wish to thank you for the pleasure of getting to know you. I wish to thank you for the positive role modeling of compassion and understanding for others you demonstrated for us. I hope you realize how large an impact you had on me and my classmates. You are a kind, old soul. And again, I thank you.
So here is a quick synopsis of things I have gleaned from my time in mental health, which I will call "Practicing What I Test Well In." [or perhaps, "How Did You Not Know That, Caitlyn? 'Cause It's More Difficult Than It Sounds, Rude."]
-- like the title of this blog posts suggests, vulnerability is not weakness. possessing the courage to reveal yourself to another is a strength that not everyone is capable of displaying, no matter how evolved the individual claims to be. vulnerability and bravery will not always pay in dividends. you may be disappointed, even heartbroken, but this should not be a deterrent.
-- primitive instincts are still very much alive. territoriality scares the shit out of me. I typically need three weeks to feel at ease with a person/place/thing, a luxury not afforded to an ADN student. my unease was always there, I just never had to journal about it and confront it before.
-- fake it till you feel it. the mind is a great and powerful force, capable of hurting and healing itself. I read an article online about the phenomenon in which acting in a certain way causes brain chemistry to adapt to your state of being. for example, the other night, I went in with the mindset that no matter how paralyzed by fear I was, I would force myself to walk in confidence. and you know what? it worked. I didn't stick to the strict script we are taught in lecture. I cursed myself for initiating a handshake, but all the client wanted to know was that I cared about them. and all that self-doubt and worrying and other silliness just didn't matter because all I need is empathy. I don't need a task to hide behind, like I did in Med-Surg. I just need to walk in heart-first, and I'll be fine.
And if I may share another story with you, I'll include no identifying information, just that information which I feel is essential for everyone to realize. A client who could easily say he or she had "The American Dream" in his or her pocket was admitted to the unit. On paper, everything was great: a happy marriage, a high-power position, a beautiful family, home ownership in the suburbs, good friends, etc. And yet, one day, the client booked an appointment with the family primary care physician and expressed feelings of depression. During the conversation, the PCP explained that in order to diagnose the client with depression, the client would have to exhibit at least five signs. The client demonstrated eleven. The client entered a crisis intervention program, and 4/5 of the way through the program, the insurance company pulled the plug on coverage. Finding no closure, the client returned home. About two weeks later, the client was home babysitting while the client's partner was out with friends and kissed the children for "what felt like the last time." When the partner returned home, the client shared these feelings with the partner, who called in backup to ensure the client's safety until a plan could be set in motion.
I feel this story is important for everyone to hear because the client's physician and family modeled excellent strategies to deal with depression. The partner did not take the client's feelings personally; instead, the partner reached out to their shared social support system in time of need and got the client the help the client needed. The physician did not dismiss or overlook the concerns of the client. Some terrifying fraction like one third of all people who attempt and succeed suicide see their primary care physicians within a week of the attempt. The number of individuals grows even larger, to something like three-fourths,who see their primary cares within a month of suicide. Every day, those with burdened hearts cry out for help and go entirely unnoticed. As a future nurse and citizen of humanity, I seek to keep an open mind and open heart to make fewer of those voices slip through our fingers.
AND IF YOU READ NO OTHER PART OF THIS BLOG ENTRY, LET IT BE THIS:
Sometimes, depression isn’t “caused.” It lies. It grows. It destroys. But mostly, depression just is. Outside things, other people, and accolades cannot make you happy. You have to make you happy. And sometimes, your brain chemistry makes it impossible to do so without drug therapy. Hearing this story – I think – made me really understand that mental illness is not a choice. It is not a product of your environment. It is not an unfortunate side effect of your life, decisions, and circumstances. It is a chemical process. Can depression be influenced by these things? Absolutely. But are these factors always a mean to the same end? no.
So walk in love, equipped with this knowledge, as I plan to do.
and if by some crazy happenstance, dear client, you find my blog, I wish to thank you for the pleasure of getting to know you. I wish to thank you for the positive role modeling of compassion and understanding for others you demonstrated for us. I hope you realize how large an impact you had on me and my classmates. You are a kind, old soul. And again, I thank you.
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