Re-Discovering Wonder

IMG_3214(1)This is a not-so fabulous picture of a fraction of the exterior structure to climb and explore at the City Museum (and yes, that is an actual airplane–go ahead, check out their website, they have way better pictures than I do) in St. Louis, MO. I visited City Museum for the first time a few weeks ago, and I have struggled to describe it ever since. The best description that I’ve come up with is this: part architectural salvage, part art project, part jungle gym, part museum complete with bug specimens, part maze, part full-size Chutes & Ladders game–all amazing. I heard another visitor say, “Every time I come here, I can’t even believe that something like this exists.”

Since my visit, I haven’t been able to shake the sense of wonder that City Museum inspires. Wonder at the creative vision to begin such a place initially. Wonder at the vast amounts of time that have been invested in every corner of the space. Wonder at the improbability of the whole thing.

That has served as a reminder to me that we need to be in touch with our sense of wonder. Between the day-to-day requirements of getting through life, and the barrage of upsetting or infuriating news that we are bombarded with, it is easy to begin to feel jaded, bored, or hopeless.

Places like the City Museum, spaces where a wild, wacky, creative, larger-than-life spirit has been given free reign, function a lot like the mountains or the ocean do for me: as “wonder generators.” After I’ve been in contact with these kinds of spaces, I notice that I feel re-energized and more ready to re-engage with my daily tasks. Wonder seems to be an antidote to the anxiety and other struggles that accumulate in my daily life.

So, this week, I’m inviting you to find a “wonder-generator” of your own. If you can’t work in a trip to St. Louis, then maybe your local art gallery or city park will do the trick.

If you feel inspired to share your “wonder-generators” in the comments, you will be welcome. If you have lost touch with your sense of wonder and aren’t sure how to get it back, feel free to contact me directly for support.

Healthy Doesn’t Equal Superhuman

This post was originally shared at the website for the #MedPsych tweetchat.

I started to touch on this point last week in my post about honoring vulnerability. And we’ve had some great discussions about the issue of vulnerability and health over the past few weeks in #MedPsych chat (check out the transcripts here). And there have been comments made during this entire year of the #MedPsych chat that have led to this topic.

Being healthy (in body and mind) doesn’t equal being superhuman.

I think that if I said that to the average person on the street, they would agree with me. But, the truth is, we kind of expect superhuman–from ourselves, from our patients/clients, and from our healthcare providers.

  • We expect that we will never fall ill.
  • We expect that we will perfectly manage our chronic health conditions.
  • We expect that we will always communicate our needs well.
  • We expect that we will intuitively choose healthy habits.
  • We expect that we will never need to restart our healthy choices.
  • We expect that clients will keep appointments, even when their lives are in chaos.
  • We expect that patients can make behavior changes, even without education and support.
  • We expect that clients and patients can communicate their needs on our timeline.
  • We expect that our healthcare providers will be completely up to date on current research.
  • We expect that our healthcare providers will start all appointments on time.
  • We expect that our healthcare providers will take as much time with us as we need.
  • We expect that our healthcare providers will be able to connect empathetically with us as fellow human beings.
  • We expect that our healthcare providers will have good enough boundaries not to burden us with their struggles.

And that’s just a tiny sampling of the expectations that we have–for ourselves and for our healthcare providers–when it comes to health. Laid out like that, it becomes pretty easy to understand why we often feel blamed and judged in healthcare, on all sides of the treatment equation.

It seems clear to me that all of these threads: countering stigma, honoring vulnerability, and acknowledging human-ness are essential components of building a healthcare system that truly honors and integrates support for whole people (body, brain, relationships).

I think one area to start changing our expectations is in our training systems. We need systems where students who set healthy boundaries are respected, not judged. We need training systems where mistakes are treated as opportunities to learn, not moments of public shaming (or a rush to risk management). We need training that give us permission and tools to consider our work as part of an integrated system, not isolated silos of expertise.

And sometimes, we just need to pause, and honor the fact that being human is a process of learning and relearning, of connecting, of struggling–a process, not a destination.

Why is Restarting so Darn Hard?

If you are a regular reader of this blog, you might have noticed something during the summer. The blog stopped being regular. I dropped from one or two posts a week to less than one a month over the summer. And it took me most of September to get re-engaged. I’ve had breaks from posting before, and I’ve written about restarting, rebooting, reconnecting. Often those posts are about the reasons that we get disconnected from things that we enjoy, or things that are healthy for us.

This time around, I have been thinking about why it is tough to get restarted.

I love to write this blog. It allows me a creative outlet and it gives me a space to contribute to better brain health information online. Writing challenges me to keep thinking and growing, so that I can keep sharing new perspectives (not new ideas, because I don’t know if there are that many new ideas in emotional health). And yet, even after I was out of the craziness of my summer schedule, it has been incredibly hard to get back in the groove.

This has been a great reminder for me about other restarts that can be tough.

  • Restarting healthy boundaries
  • Restarting connections to values and priorities
  • Restarting self-care in the form of exercise, or eating healthy
  • Restarting emotionally challenging work like therapy or journalling

I believe that our difficulty in restarting is directly connected with the post I wrote a few days ago about vulnerability. When our routines get interrupted, that feels like a failure. When we re-engage with something that we care about, we open up the risk of failing again. So, restarting a behavior that has been stopped means being vulnerable to the challenge of maintaining a healthy routine. When we admit and announce a goal, we become vulnerable to the possibility that we will not reach it.

Being vulnerable is scary. And it can be easy to let that vulnerability paralyze us.

A lesson that I keep learning is that it is better to start and get interrupted than to remain still. I may not reach my goal of blogging every week (or making healthy choices, or being exactly the parent I want to be). But I have a hell of a lot better chance of getting to that goal if I am in motion. And even if I don’t make the goal, I have made progress. I have grown and stretched and produced. So, once again, I am restarting.

What do you want to restart? Feel free to share in the comments or contact me directly.

Honoring Vulnerability

This year, I had the chance to participate in two fantastic panels at Stanford’s Medicine X conference. You can see the video of the panel on chronic illness and depression here://
The video for the second panel will be available later this fall. The great thing about panels is that you get an authentic discussion, a give and take that is really valuable. The tough thing about panels is that you often think about the things you wish you had said later on (maybe that’s just me).

So, this post is about those things. The things I wish I had said–in both panels. Because at the heart of all of the work I do with my clients, the advocacy I do online, and the writing I share in this blog is this conviction: [tbpquotable]We are all unique, fascinating, fallible, fragile, resilient human beings.[/tbpquotable] In spite of marketing that suggests that we should never be sad, never feel pain, never experience illness-each of those experiences is a part of being human. In spite of a culture that demands invulnerability and infallibility, we are both vulnerable and prone to mistakes.

So, I wish I had said these things:

  • We need to give our doctors and other health care providers permission to experience and claim their own pain, fear, sadness and vulnerability.
  • We need to talk about the amazing learning potential in our mistakes.
  • We need safe space (in our heads, in our workplaces, in our training environments) to have moments of vulnerability.
  • We need to counter shame and unrealistic expectations.
  • We need to challenge the damaging perfectionism that pervades our healthcare system.
  • We need to respect the courage it takes to admit when you are hurting, or scared, or depressed, or anxious.
  • We need to support one another’s humanity more and better.

The statement I made that was tweeted the most was about the need to decrease stigma around depression and other brain health struggles–both in medical patients and in medical providers. In order to decrease stigma, we need to increase our understanding that vulnerability is a fundamental human experience AND our compassion and empathy for the pain and difficulty that vulnerability can bring.

I’ve been having a conversation about vulnerability with the #MedPsych tweetchat community over the past week. We’re continuing that conversation tonight at 9:30 pm ET. You are welcome to join us.

Medicine X and the Sneaky Impact of Stigma

This post was originally shared on the #MedPsych blog, but is cross-posted here for my practice readers.

 Ten days ago, I had the privilege of joining the participants at Standford’s 2014 Medicine X conference. I’ve written about this conference on my practice blog before, and it is a gathering with lofty aims. The conference was initially envisioned as a space to explore how health and emerging technology support one another. Over the three years it has been running, Medicine X has become the leader among healthcare conferences at integrating patient voices into the planning and narrative of the experience. This year, Medicine X invited some discussion of brain health related issues. One panel focused on the interaction between chronic illness and depression, and another focused on how brain health issues cut across diagnoses to be a “missing link” in whole person healthcare. I was thrilled to participate in both of these panels, and advocate for an issue that I believe is essential as we move into the future of healthcare.

Participating in these panels was a joy–I shared the stage with some courageous advocates whose stories are very powerful. However, my participation also reminded me of a critical topic.

Stigma is the elephant in the room when we are talking about integrating brain health more fully into healthcare.

I have written a bit about healthy privilege and the stigma of illness, so I won’t repeat that here. There is also a great deal of powerful writing about the more obvious ways that brain health issues are stigmatized. One of my favorite reminders of this is a pointed cartoon:

This cartoon cuts to the heart of the most obvious brain health stigma–which seems to be founded on the idea that brain health can be improved just by “adjusting your attitude” or “trying harder.” That piece of stigma is very real. So is the piece of stigma that has cost individuals facing brain health challenges their jobs or their relationships.

However, what I saw at Medicine X this year was a more challenging and subtle component of stigma. I saw an assumption that brain health issues are something that patients deal with, not a challenge that confronts health care professionals. People were willing to talk about providers who were burned out. They were much less willing to talk about providers who might be facing depression, anxiety, unsustainable stress levels, etc. That language still seemed taboo. And that’s a problem. As long as brain health challenges are something that “they” experience, stigma will continue. As long as it is not acceptable for a medical student to own that the intense demands of their training are difficult emotionally as well as practically, stigma will continue.

I also saw brain health discussed as something “other.” Medical students talked about not knowing how to approach a referral for brain health services without upsetting their patients. Until a referral for a brain health consultation is as automatic as a referral to an endocrinologist, stigma is still at play. Until we are trained to think about the brain and our social functioning as a vital component of health that we wouldn’t dream of ignoring, stigma will still be an issue.

I don’t want this post to be construed as pessimistic. At Medicine X, I heard medical students ask questions that showed they truly want to be part of this conversation. I saw patients who discussed their depression as a medical challenge on the same stage with diabetes or autoimmune disorders. I saw that there is so much hope and potential for the future.

I also saw that we have work to do. Let’s keep the conversation going. Shining a light is how we challenge the grip of stigma.

Being Brave

One of the things I love about psychology is the chance to routinely sit with really brave people. These aren’t necessarily the folks who do dangerous jobs or who would be recognized as “brave” outside of therapy. In fact, many of my clients believe that they are ordinary, or broken in some critical way. But the truth is, we are all broken. Most of us who have lived long enough have been broken in some critical way at least a few times throughout our lives. I know I have. Being brave isn’t about painting your face blue or rushing into battle.

Being brave, at least in my book, is allowing yourself to sit down and face your own broken pieces. To come to terms with the pain that you have lived through–or are living through. It means having the courage to acknowledge that, alongside your brokenness, you also have some fantastic qualities, things that make you interesting, worthy and meaningful in the world.

Because we live in a culture that tells us we aren’t all of those things. In fact, our society likes to celebrate someone interesting and then tear them down when their brokenness & humanity show up, along with their talent. So, when you take the time to face your pain, and then to discover the strength underneath it, you are being courageous and counter-cultural.

Being brave includes being willing to cry, or shout, or question. It isn’t some fake front. It means standing up and owning your imperfections, acknowledging your struggle, and still finding joy and making beauty anyway.

Every person who chooses therapy is meeting my definition of bravery, just by walking in the door. Because the work that we do here is hard. It can get messy. And it’s not how you normally interact with people. (Who else do you know who buys her tissue by the case?) Coming here is an act of courage. Imagine what else you can do, now that you’ve gotten in touch with your inner brave person!

How have you been brave recently? What do you want help in finding your brave for? Feel free to share in the comments. Oh, and for some bravery inspiration, here is Sara Bareilles performing her fabulous song “Brave.”//

You can be amazing
You can turn a phrase into a weapon or a drug
You can be the outcast
Or be the backlash of somebody’s lack of love
Or you can start speaking up

Nothing’s gonna hurt you the way that words do
When they settle ‘neath your skin
Kept on the inside and no sunlight
Sometimes a shadow wins
But I wonder what would happen if you

Say what you wanna say
And let the words fall out
Honestly I wanna see you be brave
With what you want to say
And let the words fall out
Honestly I wanna see you be brave — Sara Bareilles

Privilege and Stigma in Health: Revisited

Last year, I wrote a series of posts about the idea of healthy privilege and health stigma. My definitions of these concepts were based on the work of others before me, such as Peggy McIntosh and Kendall Clark. You are welcome to go back to the original posts and read them, but I’ll share the definitions again for you.

health stigma

The feelings of shame, isolation, self-blame and invisibility that many people facing physical or mental illness feel when others make assumptions or judgments about their ability, willpower, character, motivation, or work ethic (to name a few)–Ann Becker-Schutte’s personal & professional experiences

healthy privilege

1. A right, advantage, or immunity granted to or enjoyed by healthy persons beyond the common advantage of all others; an exemption in many particular cases from certain burdens or liabilities. b. A special advantage or benefit of healthy persons; explained by reference to divine dispensations, natural advantages, gifts of fortune, genetic endowments, social relations, etc.
2. A privileged position; the possession of an advantage healthy persons enjoy over persons with illness.
3. The special right or immunity attaching to healthy persons as a social relation; prerogative.

In addition to the formal definition, I would add this:
Healthy people enjoy the privilege of bodies that work in the ways that they expect, free from regular pain or suffering, without extraordinary effort. Healthy privilege allows healthy people to assume that their experience is “normal,” and to be unaware that coping strategies that work for them will not work for someone dealing with illness.

If you’re familiar with the definitions, thanks for your patience in rereading them. I’ve been thinking about this issue again this week. These concepts have been on my mind again because I’m hearing things from my clients, and in the communities where I participate, the remind me that health stigma and healthy privilege still alive and kicking.

I wrote about another aspect of this issue a few weeks back, when I talked about shame and patient blaming in healthcare. And just last night, during a discussion on Twitter, a patient shared this experience:

@MedImprovePro: Cancer still stigmatized. BRCA+, but told by co-worker nurse ‘you wished that on yourself’.

I was floored. Absolutely stunned. How on earth is it possible that we still have people, let alone healthcare providers–who should damn well know better, who believe that cancer is something that we can “wish upon ourselves.” And why on earth would anyone make that choice?

I should know better than this. I hear my clients tell me about the shaming and blaming they face both in and out of doctors’ offices on a regular basis. I hear about the blatant discrimination against folks with all kinds of diagnoses, both physical and brain-based. I know this is out there.

But I believe that we can do better than this. So, if you’re reading this post, I hope you share it. And I hope that, as you share it, you look at one step you can take to educate others about health, health stigma, & healthy privilege. Because it is going to require all of us taking action to build and generate change.


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