things I think about when I have time to think

A GP's spin on mindfulness: You are not your thoughts

2012-11-03T11:59:00.002+11:00

40% of the Australian population has a diagnosis of mental illness at some stage in their lives.

50% of those with a mental illness also have a significant physical illness at the same time.

Staggering statistics. It is not a stigma, it is not a rarity,..... it is Truth in General Practice, every day.

My natural reaction with these patients had always been to listen with sympathy, sometimes even personal empathy, ...to give them my full attention, ...and then to linger a little longer in the quiet of my own thoughts, often absent-mindedly carrying these burdens home with me.

Sometimes I lingered too much, and my family began to find that my mind was too often elsewhere... I began to identify with the reality of GP burnout.

Yet every day there was someone new who needed help, ....help that I did not feel equipped to give. And my role continued to be one of listening, and encouraging patients to seek formal therapy, ....with psychologists, psychiatrists, people who had special training in these areas.

The thought of approaching psychotherapy myself seemed too huge a step into a vast unknown territory. And I didn't dare to even try.

But in referring these patients on, I encountered so much resistance.

The patient had already taken the big step of entering my consulting room, had connected with me, had shared intimate and often painful stories, and was most reluctant to venture any further.

Some had already been down the psychotherapy road and had bad experiences. Some just weren't ready to take yet another huge leap. And sadly, many had lost all hope. My practiced response was always to encourage further, to endeavour to find that perfect therapist for them.

Yet time and again, they returned to me.

And time and again, beyond my sympathy, I felt helpless. Sympathy, empathy, and the listening ear is a natural humanistic and caring response, but it is not truly helpful in leading a patient forward.

"A fool keeps doing what he has always been doing, yet wonders why nothing ever changes".

This is a "Karism", something that my husband often quotes when he helps me wrestle with dilemmas.

And so it dawned on me that I had to change the way I had been practising.

The way I was doctoring these patients was not enough, yet paradoxically, sometimes it was, in fact, too much.

I needed to learn tools to empower these patients to manage their mental health, ....and part of that meant stepping back a bit, aiming to become the facilitator, the supporter, but not the problem-solver.

......So began my journey into mindfulness and ACT ( Acceptance and Commitment Therapy).

It is a huge field, far beyond the scope of this brief blog, but extremely worthy of a nutshell description to perhaps spark your own journey.

ACT is entirely different to traditional CBT (Cognitive Behavioural Therapy), in that the concept is not to avoid the negative thoughts and feelings that are plaguing the patient, but instead to teach the patient skills to acknowledge the recurrent patterns in their thinking and then to learn to defuse them.

The constant inner dialogue we have in our heads is not truly US. These are mere thoughts, subconsciously collected from a myriad of external expereinces, opinions, subtle inferences and anything else that the mind has gathered over time.

This constant dialogue runs parallel to, yet separate, from oneself. And being able to separate the two, and acknowledge the "observing self" as separate to the "thought dialogue" is the first step towards understanding ACT.

The goal is to become comfortable with acknowledging the thought patterns, even taking the next step of "labelling them" as the recurring "I'm not good enough to do anything" thought, for example, ....or the "I had a bad childhood so I will always be a mess" story, ....or even the "I'm not pretty, I'm fat and ugly and no one ever likes me" thought....

There is no need to ignore them, to try to stifle them or to wish them away. But there is equally no need to believe them.

And some patients eventually even reach a point of being able to regard these thought patterns with humour when they surface -

"Oh yes, ....that's the 'My parents don't love me as much as my sister' story. Yes, I know that familiar story. It's here again, ....but that's okay, it's just a thought, it will come and it will go, but I will remain."

Sometimes, it helps to repeat the story label in a comical voice or to a ridiculous tune. And it defuses it; the thought loses it's power to destruct.

Imagine, for a second, singing "I'm so ugly" to the tune of Jingle Bells in your mind without breaking into a smile!

Yes, the thoughts will still come and go, ....but we can now make space for them. We can just "sit with them", without feeling threatened or drawn in.

And gradually, as we get better at this, we can see these thoughts more clearly for what they are - mostly untruths not necessarily based on any facts.

Our thoughts are not "us", and we do not need to react to them. We can rather choose to act in line with the values we have pre-defined as important to us, to choose to act based on who we want to be and the life we want to live.

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So now, when I see these patients in my appointment book, I am excited. I'm eager to see how they have progressed since our last appointment, and I have tools to offer them when they have the inevitable hiccoughs.
I can offer more than a listening ear, I can perhaps reach and help them.

And see real change.... and most of all, hope.

.....And for the ones who are not able to move forward for now, my listening ear is enough. And I respect that too.

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Some interesting links if you want to read further:

http://www.thehappinesstrap.com/

http://www.actmindfully.com.au//home

The strength of women

2012-09-15T11:55:00.003+10:00

I was speaking to a struggling friend at church tonight...

....and reflecting once again on how we were never meant to live under the extreme pressures which are placed upon us.

And yet, as women, most of us willingly take on these pressures, seeing it as normal to continually strive to do it all and be it all.

I believe that God's design for us was to live in communities, caring for each other, nurturing, living together side-by-side as families and friends,

...not isolated in our expensively mortgaged houses, struggling to maintain the expectations of coping, doing it alone,

....either as working mothers, single parents, or stay-at-home mums struggling to meet the demands of caring for children without the generational support of grandmothers and aunties and neices to help,

....while our husbands, and often ourselves too, are out working long hours to pay for the lifestyles which we think we should be leading.

I see this as one of the major contributors of maternal depression. We raise our children with so little real support, and with such martyrdom, that we sacrifice so much of ourselves while we do it.

We should really be upholding each other, nurturing one another, not adding to the self-critiscm that we already so lavishly dole out upon ourselves.

I have a heart for these women .....because I know how it feels to strive for this type of I-can-do-it-all perfection,

.... and I now know how much better it is to live in the freedom of really knowing and really believing that it is okay to not be perfect and to not have to do it all,

....that the fleeting image is just not worth holding on to.
There is perfection in your imperfection, ...chosen to be wife, mother, sister or friend uniquely for your loved ones.

And you don't have to do it alone.

Believe it and live it.

And hold another woman's hand so she will believe it and live it too.

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Who do I write for....?

2012-08-26T22:06:00.000+10:00

A blogging friend, Mrs B, recently posed this question - Who do we write for?

I HAVE to write… I always have...

....it’s like thinking for me… processing something.

For a long long time, I didn’t write, ....just little jots here and there in so many notebooks scattered throughout the house, that they followed no real cohesion… the early blurred years of my parenting…

....taking a few moments here-and-there to write down a thought while a child napped, or I stirred dinnner,

…I kept meaning to collect all the bits and collate them, but the collected fragments are all still in shoe-boxes gathering dust,

…and I’ve probably moved on… a season that has passed.

I think during that time, a small part of me was dying... In all the busy-ness of life, ...I just didn' t know it.

Then one day, I just sat down at my computer and started a blog – BAM!

How awesome it is to put my millions of thoughts into words, just for ME, but really, ....hopefully,.... as a gift to others, and it can clear my headspace, and make life simpler, lighter.

Then there's the other benefit – all those wonderful connections I make and the redemption of my sanity – some people DO actually think like me too, haha!

Doctoring and mothering and writing is a juggle,

...but the writing has to stay – as my friend, Mrs B, says, it IS essential!

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little girls, tea, and friendship....

2012-08-03T02:01:00.001+10:00

Little girls learn early that tea and friendship go hand in hand.....

I'm reflecting on a wonderful afternoon with 3 very special God-given friends, lots of cups of tea and heart-felt words...

God gave me a man to so tenderly love and to hold me, but He also surrounded me with women to live alongside.... raising our children together, sharing our stories, encouraging one another, nurturing...

These simple things, so freely given carry such worth and weight in my life.

From girlhood to womanhood, we need tea and friends....

The joy of a child, God's greatest gift...

2012-07-28T09:30:00.000+10:00

This blog is dedicated to Lisa and Seth, the Friends we call Family.

My best friend, Lisa's, beautiful 4kg baby boy was born yesterday.

And today my clucky self got to hold warm sweet Samuel against my chest and breathe him in,

...rocking him gently, eyes tightly shut, little mewing murmers,

...and kiss his downy head,

....unpeeling his newborn clenched fists, so I could wrap his tiny long fingers around mine,

...and hold his flat onsie-d feet in the palms of my hand.

There is nothing like the joy of a newborn child,

...all that newness,

....and yet the knowledge that you will watch him grow...

....and become,

....and BE...

God's greatest gift to you.

In the words of Solomon, the wisest man who ever lived,

"Don't you see that children are God's best gift? the fruit of the womb his generous legacy? Like a warrior's fistful of arrows are the children of a vigorous youth. Oh, how blessed are you parents, with your quivers full of children!..."

Psalm 127:4 (The Message)

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Rememberies of babies... For Lisa

2012-07-26T15:43:00.002+10:00

this blog is dedicated to my best friend, Lisa, who has just today delivered her brand new Baby Samuel...

When our own babies were this age, my husband used to say that Solomon, in all his wisdom, left out perhaps one of THE most pleasurable moments in his account of these in the Bible...

...and that is the sweet breathing heaviness of a sleeping baby on your chest,

....their milky soft skin against your own,

....the rising and falling of your own breaths as you absorb their weight,

....just resting in that protected moment, watching them in that perfect repose,... lips puckered, downy head,

.... soaking in the beauty of this new life, the one who has your eyes, or his nose, ...or maybe Grandpa's hair,

...there is the delight in discovering it all and just pausing for that time and cocooning.

I will always remember that and savour it.... the rememberies of my sweet 5 babies, watching them grow.

And needless to say, we were the type of parents who enjoyed as many cuddles as we could....

...trusting that, swathed in our love, our babies would settle in their cots when there was no chest to lie upon. And all 5 of them did - most of the time :)

Nothing could have replaced those bonding moments we spent with our 5 babies. My husband still speaks of them wistfully,

....always adding them to Solomon's greatest pleasures and giving them top spot.

(in the words of Solomon from Psalm 127:3-4, The Message...)

Don't you see that children are God's best gift? the fruit of the womb his generous legacy? Like a warrior's fistful of arrows are the children of a vigorous youth. Oh, how blessed are you parents, with your quivers full of children!

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I Believe in You

2012-07-23T04:50:00.002+10:00

"I believe in You."

Every time he comes to see me, I tell him the same thing, "I believe in you".

And he always responds the same way. He looks at me, teary eyes, and pauses,.... lifts his face to mine, ....soaks it in, ....and then slowly brightens.

"No one else has ever told me that," he says. Every time.

Paul has been my patient for several months. He has an addiction to alcohol, and as such, cannot work. I have organised social benefits for him and psychotherapy, and slowly started the process of counselling him to address the problem with his substance abuse.

"I believe in You."

This has been the most powerful therapy I have been able to provide him so far. It is what has kept him coming back to me each week, sometimes more than weekly. And it is how I am reaching him, slowly unpeeling the layers of his damaged life.

Paul's mother has been married and divorced several times, and he grew up in an unsettled environment.

Of his 4 sisters, only 1 of them has not been addicted to heroin. One overdosed and died, one is still using, and the other has managed to give up and is trying to rebuild her life.

His fourth sister is a successful professional, but he has little to do with all of his family as they live interstate.

Paul also has a grandfather who committed suicide, and a depressed uncle who just disappeared, presumed dead. It is the reason why Paul will not consider antidepressant therapy as part of our management plan. He blames the medications for the loss of his uncle.

Paul's main reason to live is a 9 year old boy, his son. And when he speaks of him, his countenance lightens. His life is for him. It is the one protective factor, and it is the one that I use to motivate him to change.

So every week, Paul visits me. And every week, we talk. Sometimes he has improved and managed to abstain and be productive. He is excited and is willing to set a quit date and to try the medications I offer him to stop the cravings.

But then there are the weeks when he relapses. There has been a crisis with his accommodation. Or a difficulty with access to his son. And he returns to the alcohol. On those occasions, he comes in and confesses, so angry with himself, at his failure.

"I
 believe in you Paul. You are here. Because you want to change. Because 
you have a little boy in your life who loves you and wants you around 
and who you want to be there for. You have a life worth living and 
saving."

And his hunched shoulders lift. And he walks out straighter, with new resolve.

I know this is a long-term issue. It may take many months and several detox attempts to help Paul. But, as I tell him, I am here. I will be here for him through it all. Not to "fix" him, but to collaborate with him. To help him with his goals, to help him fix himself. He is my patient, And I believe in him.

"Be kind, for everyone you meet is fighting a hard battle" - Plato

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a guest-blog: The Hatchet

2012-07-13T16:55:00.000+10:00

a guest-blog: another story written by my 12-year old, Tianna MooShoo

The Hatchet

English Assessment

Year 7, Term 2, 2012

By Tianna

Just a week ago, my younger-by-a-year brother came back from the wilderness. He hasn’t acted this strange before, not even when he could only say “dada” and “mama”, because even back then he made more sense! I am not talking about the crazy weird, I’m talking about the kind of weird where you think your brother is super annoying, but after two months, it’s like you don’t even know him!

I guess I can’t blame him. He was on his way to our Aunt Kristy and Uncle Robert’s house in Scotland, because I went last year and it was “his turn”. Anyway, he was in a two-seater plane with a pilot named John Bentley. Apparently, the pilot had just been telling Jacob all about how he felt like eating a burger, when, all of a sudden, the pilot had a heart attack. Since Jacob had no idea what to do, and since the pilot was either dead or in a coma, Jacob took the wheel. He had no idea how to fly a plane, but it was better than crashing, when he might have been able to save himself ... and he did!

He landed in a lake and got out just before the plane sunk. Unfortunately, he was stuck in the middle of the wilderness. But he managed to survive. He built a shelter, learned how to catch and cook food, learned how to make a fire, etc.

Unluckily, he was also stuck in terrible weather conditions, including a tornado! One night he remembered an emergency pack in the plane. The next day, he set out to get it out from the sunken plane, but it wasn’t easy. He relied mostly on his one and only man-made tool, his hatchet.

When he finally got out the pack he looked in the contents and found supplies. He ate the food inside before trying out the emergency transmitter. A pilot nearby heard the transmission and came to the rescue. He was taken home and was all over the news, because he was only 11 years old, and had survived 2 months, when other adults had died within a few days in the wilderness.

But still, he’s been acting pretty different. Just take last Saturday afternoon for example.

I was just fetching my famous double chocolate chip cookies from the oven to welcome him home (Even though he has been home for a week now, everyone has been treating him as if he got home yesterday), when he walked in, sniffing the air, and curiously turning to me, he said, “ What’s that weird smell?”

I wasn’t sure what he meant. “What? The cookies? But they’re your favourite!”

“They are?” he said, as if it was the most fascinating thing he had ever heard. “They smell good in a way, but really weird at the same time. In the wilderness, a treat would be a quail or some raspberries. I remember adoring those cookies, but they smell strangely different now.”

I curiously smelled the cookies. “What do you mean? They smell exactly the same! I think too much time in the sun has cooked your brain silly.”

He grinned and said “Yeah, maybe. But all that “brain cooking” sort of helped me, but it didn’t help me at the same time. It didn’t help me because I guess it’s the reason why I forgot how to read and write, but it helped me because it sort of made more room for me to learn how to take care of myself.”

I laughed, and said “Well, I have to admit, you’re lucky in a way. The teachers at school felt bad for you, so they gave you two months off so that you could re-learn how to read and write and to catch up. And they also said if you needed any extra time, they would be happy to give you more time. You’re soooooo lucky! Especially because I have exams coming up!”

Now it was his turn to laugh, and he said “Yeah, I’ve gotta admit that I am happy ‘bout that. Could you please pass me a cookie?”

I was stunned and said “You said please! We have been trying to get you to say that for 11 years!”

He shrugged and said, “Yeah, well, I have definitely changed. This is kinda embarrassing, but you have no idea how much I missed you.”

I was touched, yet stunned again. Who was the polite young boy? Jacob had never said anything like this before. “Okay, who are you and what have you done with my brother?” I joked.

He seemed confused. “What do you mean? I am Jacob! I haven’t done anything to anyone!” He started to sound worried.

It was getting weirder by the second. He and I used to say stuff like that all the time. But he started looking really worried so I said, “No, no, no. I was joking! No need to be worried.” But now I was beginning to get worried.

“Phew!” he sighed, “I was getting worried. I guess I have started to lose my sense of humour since I haven’t had anyone to annoy.” He smiled.

“I have to admit,” I said “before we knew you were missing, it was a lot more quiet and peaceful. But as soon as we heard the news, the house was crazy! There were people crying (aka, Mum, Dad and the rest of us kids) ,there were police and reporters coming over to ask questions, and there were lots of adults/teachers/pastors/family/friends coming over with plates of food. Three people even offered to help with the funeral!”

We both laughed. As I put what was left of the cookies into an airtight container, the phone rang. Again. That phone had not stopped ringing since we found out that Jacob was missing. But once he was rescued, the amount of phone calls doubled. “Probably another one of your friends or teachers, or maybe even another one of those pesky reporters that haven’t stopped bugging us!” I laughed.

We listened as Mum answered the phone, “Hello? .... Yes, that’s me. May I ask who this is? .... Hello Kristy! What can I do for you? .................... Oh! You would do that? Oh thank you! .... sure, he’s right here.”

We heard her pause, and then yell “Jacob! Aunty Kristy is on the phone and wants to speak to you. She wants to organize a welcome-back-Jacob holiday. Fortunately, she and Robert are coming over here instead of us going there, just in case you are still scared of planes. Then we are driving to Sydney to stay for the week. We organised it yesterday, but she just said she was going to pay for it all, because a friend she knows works at the hotel and will give us a discount. Be sure to thank her!”

Jacob smiled at me, and then raced off to talk to Aunty Kristy.

I guess it wasn’t that weird, just different. Maybe different is good. Because God does everything for a reason. He gives us chances to choose from right and wrong. It’s these choices which cause different opportunities, good or bad. God went through all the hard work and set up the course of life, and all we have to do is follow it correctly and faithfully.

So, maybe He made this crash happen on purpose. Maybe He did it so that Jacob would become closer to God, which is exactly what happened. So unlike most people would be, I am grateful that this happened, because God does everything for a reason.

“And we know that in all things God works for the good of those who love him, who have been called according to his purpose.”

Romans 8:28

NIV bible

-By Tianna – inspired by the book “The Hatchet” By Gary Paulsen

My unanswered prayers....

2012-06-10T15:06:00.003+10:00

... of which there are so many. Unanswered, yet more-than-answered.

If He had answered those first frantic puppy-love-prayers, .....I would have been another man's wife. ....and never known the sweet wealth of being so-wholly loved, the joy of this man, this life, and this moment...

And when I boldly asked Him for three, He gave us five...

Five small souls to love and to nurture and to fill our lives with far more richness than my furtive prayers ever even knew to ask for.

And so I have learnt to be less prescriptive in my prayers.

I don't need to understand, to know the how, the why or the when.

There is rest in the heart-knowledge that our God is able, all-loving ....and His plans for us will always surpass our greatest hopes and dreams...

So today I pray "I trust You, Lord" ....and I know that it will always be more-than-enough.

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Those whom we cannot save.. trusting them to God

2012-05-13T23:41:00.000+10:00

It was a consultation I had played out in my mind many times before... a kind of role-playing exercise, practising for the one-day.

Today was my one-day.

I called them into my room, broad smiles on their faces, a husband and wife, parents of a one-year old. We exchanged introductions, I opened her file, and then asked how I could help. Just a normal regular consult.

"She's 3 days late with her period." It was her husband who spoke for her, "We think she's pregnant."

I smiled. This was good news. They, too, were smiling. "Have you done a home pregnancy test?"

"No," it was the husband who spoke once again. "We thought we would come straight to the doctor... because we don't want it. And we need to make arrangements to abort it as soon as possible."

The entire consult slowed down for me here... I heard myself speaking, asking about their contraceptive usage, offering the woman a specimen jar, ushering them out of my office to the bathroom down the hall.

And then they were gone. And I was alone again. Heavy, teary, trying to compose myself.

But all I could focus on was the image of a tiny baby bobbing around in the patient's womb, growing, being nourished, ....oblivious to the limited window of life left.

The couple returned with the urine jar, I placed a few drops onto a test strip, and the 3 of us watched and waited in silence. Negative.

Still in automatic pilot-mode, I printed out a form for a blood test, and sent them on their way, with plans to return for the result in 2 days time.

They left.

At my desk, I rested my head on my hands, closed my eyes and cried. Soft, gentle tears. Into the hands of Him who holds me.

Dear God, I don't want to ever be a part of this. While I respect the rights of others to their own beliefs, and while I will not project my own onto them, ...I struggle with my professional obligation to support something which is so against what I stand for.

...I want to scoop that baby up in my arms, to protect it, to save it, to give it what is being taken away.

Yet it is beyond my ability, my control. I cannot fix this, it is unfixable.

And so I cry, I pray, and God lifts me.

The promise is not that we will not face trials and difficulties and ethical dilemmas. But that we will be held. And I am.

The couple return on Friday. The blood test is negative, and she has since had her period. It was just late.

So I take the opportunity to discuss contraception with them. They had not been using anything, just taking their chances, but adamant that they did not have the funds to support another baby. They already have a one year old at home, employment is difficult, and they do not think they can afford a second child, financially nor emotionally.

And so, as a doctor, I do what I can do. I give them options.

The woman lights up. She had not been told of the advantages of being on the contraceptive pill. She is excited at the thought of cycling the packs to avoid bleeding for 3 months at a time, she is happy that she will have control over her periods.

And it is a win-win situation. She and her husband leave with her script. And I am relieved. There is no baby to protect, no abortion to refer for, and a patient has been given back some control.

But I know that there will be future consultations with less favourable outcomes.

Dear God, I pray that in all situations, You will grant me Your integrity, Your mercy, wisdom and grace.

But, especially when endings are not happy, Lord, ...I pray that I will do what is within my power to do, but will then find healing rest in the heart-knowledge of really-really knowing that I am being held.

...And I can trust the situation to You.

Casting the whole of your care [all your anxieties, all your worries, all your concerns, once and for all] on Him, for He cares for you affectionately and cares about you watchfully.

1 peter 5:7 (Amp)

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