Think about your thoughts …

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Our minds control our lives.

We often say to other people  “Try not to think about it” , “Don’t be so negative” or “Try to be positive.”  What we are really saying is, “Change your thoughts and perceptions about the situation.”

We often reflect with our words the reality that most of our experiences are based on our thoughts and perceptions.  Our lives are basically dictated by the ideas and concepts we have in our minds.  The interesting thing is that most of the time we do not realize it.

Our minds are so powerful, and yet we don’t recognize that we can control it so that we can control our circumstances.  In other words, we are able to change the way we think if we choose to.

The challenge comes when we unconsciously identify with whatever it is that we have chosen to value in our lives.  And we identify with it simply because we do not want to accept the inevitable fact of our mortality.  And it becomes an automatic habit which we do not rethink about.  It is normal to perceive ourselves as white, black, Mr. and Mrs. Jones, a teacher, a construction worker, a mom, a dad,  a Cubs fan, an American, a soldier, etc.  It makes us who (we think) we are.

In previous blog posts, I have talked about how our thoughts and ideas can be used to feed our ego, which is the fabricated self that we keep nurturing in order to avoid thinking about our own mortality.

So we choose, or we are taught to identify with, a family name, a particular race, ethnicity, political party, profession, etc.  Simply because we want to maintain ourselves distracted and entertained with identities that help us feel alive and valued.   In other words, away from the reality of our death, the ultimate unknown.  So we keep deceiving ourselves.

Also, when we say “Good luck!” or “I’ll pray for you!”, we are basically saying that, because we cannot control or directly intervene with a difficult situation, we wish someone else a favorable outcome by thinking they may receive some assistance from an outside source beyond our control.  In other words, I cannot help you directly, but I am claiming that somehow you receive some help beyond my human capacity.

So, pay attention to what you think.   Review and contemplate on how each statement you  make can reflect the fear of the unknown.  Fear of your mortality.

Think about your thoughts.

 

 

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Feeling Bad

I have been feeling bad lately.  Let me explain.

I work as a supervisor in a mental health program.   I manage other clinicians, nurses, and psychiatrist who serve people with severe mental illness.  It is a stressful job by itself and involves a lot of therapy, case management, medical follow up, consultation, traveling, etc.  It is a job that not anybody can withstand or even consider taking, because it is not a typical mental health facility.   The program is based on the PACT model (Programs of Assertive Community Treatment) and it involves intensive psychiatric and rehabilitation services , similar to what clients receive in psychiatric hospitals, but in the community.  So you can imagine the amount or work and tension that we often experience in trying to help individuals with paranoia, delusions, disorganized thinking, and poor social skills remain living in their homes.   Even though I may be describing it as a difficult job, it is very self rewarding.  We are actually helping people stay away from institutions and jails simply because of the severity of their illness.  We are helping them live normal lives like the rest of us.

But I recently started feeling really bad about my job because of the way the company sometimes treats our staff.   They are not usually paid the salary that other facilities and hospitals in the community pay their clinical staff, plus they started hiring more bachelor levels so that the  cost of hiring people would be less.  So the competition has been an uphill battle which results in a high turn over rate.

Since I started working for this PACT program in 2011, we have had two full time doctors, and recently two part times.  The two part time psychiatrists  shared the case load of a total of 101 clients.  The last two psychiatrists were working under a contract  instead of being regular employees.  But unfortunately , one of the two part time doctors decided to move out of the state for a better paying job (its usually  because of the money) and we found ourselves planning to have one part time doctor cover  while starting to recruit for another doctor to take over the other half of the caseload.   The situation became more complicated when the company advertised the position and found a candidate who was willing to work full time instead, as a regular employee.  Having a full time practitioner is what the PACT model is based on primarily and it facilitates the overall function of the program.    So needless to say, the company had to make the difficult decision to “get rid of the part time psychiatrist” so that we can officially hire the new full time practitioner (who happens to be an ARNP who can do the same type of job as a psychiatrist).   Of course, letting the remaining part time psychiatrist know was the hard pill to swallow.  Not to mention informing the clients (once again) that their psychiatrist was resigning and they were going to be seen by a different practitioner.   Our clients who all suffer from a severe and persistent mental illness, are already marked by difficult times in their lives, and change is one of the most difficult experience which can exacerbate their symptoms.

The CEO of the company is the one who negotiates with psychiatrists and makes the final decisions about which psychiatrist to hire.  My supervisor and I interviewed the new candidate and we liked her, but the CEO was the one making the decision about moving  forward with her, meaning that the part time psychiatrist who was still working with us had to go.   Part of me said we were doing the wrong thing… that we should’ve looked for a another part time psychiatrist so that we wouldn’t have to lose the one we already had.  I was informed that the CEO would then speak with the part time psychiatrist about our plans, which I was glad I did not have to do, although I wished we could have done something different so that we can keep the part time psychiatrist.  But that was not my decision to make.

To make matters worse, last week, the part time psychiatrist approached me and asked me about what the company was planning to do with her if they find a full time practitioner.  I was dumbfounded and caught off guard, not knowing what to say at the moment.  I thought that the CEO had spoken with her about his decision already,  but it turned out he had not informed her yet.  So I had to tell her the truth at that moment, I don’t believe in lying or hiding things from people, especially staff people who work with me.   But I also told her that the CEO should be speaking with her about the matter in more details soon.  So, understandably, the part time psychiatrist seemed upset and said she will just resign.

I felt as big as an ant.

Here we are, literally getting rid of a part time person, a human being with a family to feed and a career to keep, so that we can replace her with a full time person who will take her place to “serve our clients.”  The company has a budget to keep, so having one full time psychiatrist was more financially convenient.   I understand the technicality and the business part of the reason why we need to make this decision.  But the human side of the matter sucks.

So I feel bad.  I feel we made a mistake.  I wish I could have done something different and prevent having to get rid of the part time psychiatrist.  I wish the CEO would have contacted the part time psychiatrist early and offer her to stay with maybe less hours, but still stay working with us along with the full time ARNP.

But it is too late now.  She decided to suddenly resign , sooner than what the contract mandates.  I can understand her anger and frustration. I also understand the need to have a full time practitioner who also has more flexibility with traveling and visiting our clients.

So I am split in half, feeling glad that we found a full time practitioner soon;  but still feeling bad that we lost a very good psychiatrist and made her upset in the process.

At the end of the day, the ones suffering the most are our clients, who will have to face another change of providers.  And most likely run the risk of  increasing their symptoms of mental illness because of this transition they are forced to face.

It’s hard being a supervisor sometimes.

 

Identifying with the Self: Part Two 

 I had a counseling session with one of my clients.  She is a cutter and was questioning whether or not she would be getting any better in her life.  She was comparing herself with others who also receive therapy and who seem to be getting better faster. My client thought she was not improving like she should and asked about the concept of PTSD and resistance to treatment.

I try to explain to her that PTSD involves living in the past after a traumatic experience… versus learning from the past without necessarily reliving the past.  When we experience PTSD , we tend get stuck in the past and not move forward.  When the pain is avoided then we continue to experience PTSD and continue to relive the past and experience an emotional cycle which is nourished by substance-abuse, self harming behavior, and depression.

On the other hand, when we learn about the past, we develop new skills and we develop new ways to cope with the upsetting memories.  One of the ways is to talk about it, process feelings, write about it, and accept the fact that the pain was done.   When we choose to develop new skills and process feelings by accepting the pain, then we begging to acknowledge that it was a difficult time in our life and be able to move forward with new skills.

And then there was the question of why she is still cutting when she’s in her 50s now, when most of the cutters are either teenagers or young adults.

Then a lightbulb turned on in my head. I asked my client who she would identify as and she could not answer the question.  She first said “I’m already in my 50s why am I asking this question now? ” Then I asked her to not think about her current age but to focus on the question itself : who am I?

The observation that most cutters are teenagers or young adults gave me the idea that, since she has always been dependent on others to tolerate her who she is and what to do with my life, that sounds almost like what teenagers and young adults do in the early lives.

Basically my client is experiencing what most teenagers and young adults experience : finding their identities in life, facing the unknown after depending on the parents.  My client said she always depended on her parents and she was taking care of and nourished as a child even during her adulthood.  This can explain why she has difficulty identifying who she is now in her 50s. I explained that most of us experience the same identity crisis in different times of our lives. Most of us identify with what we have been assigned to be, for example our names, our ethnicity, our gender, and our religion. But we ultimately face a time in life, usually during young adulthood, where we start questioning  our assigned entities and find our own identities. And maybe that’s what my client is experiencing at the present moment.

Like I mentioned in my previous post, we mostly live inside our heads. Inside our thoughts and perceptions. We rarely get out of our thoughts and face reality. We don’t usually live in the present moment.  But we rather stay living inside our heads.  Inside our minds. But we rarely step aside and start perceiving ourselves as we really are.

Have the rest of us done the same thing in our lives?  Have we taken the bold step of “peeling the onion” all the way until we find our true selves?

In my own experience , that “true self” remains a mystery.  It remains a great part of the unknown, which is why I tend to ignore it and replace it with all the entities I have been taught to identify with.

I have learned to identify with being a Hispanic middle age male, an American, a mental health professional, a  Florida resident, a parent, a husband, a son, and many other entities.  All of these I can question and deny if I choose to.  What I have not identified with as much is what can never question or deny.

My true self.

But what is the true self?  Is it simply being human? Being a person? After all, isn’t that what we all have in common? Identifying with being Human beings ? Anything else could be used to separate and segregate us.  But being humans could only keep us united.

Papi, what is happening to you?: The unforgiving reality of old age


Visiting my Dad , whom I call Papi in Spanish, has been a sweet and sour experience.  I came to visit him in Puerto Rico for a few days… because I miss him and  I wanted to see him again.

During the time I spent with him during these few days , I start questionning again the absurdity of this existence.   What is, if any, the purpose of this life ?  Why are we born to simply die and cease to exist at the end?

Papi was an active man who worked very hard, had many friends and went to many parties.  He was known as having a good sense of humor and making jokes all the time.  He always dressed up with the latest fashion and style.  Papi often took good care of his belongings, particularly his hair.    He also has been a jovial and friendly individual.  He laughed hysterically and made jokes with his friends about politics and life in general. He enjoyed drinking with friends and eating spicy food.

He went to the army for a short period of time, but he often reminded us of his military routine.   Papi married my mom and had four sons.  He worked hard at a pharmacy warehouse . I remember visiting him at his job which was upstairs.   Papi would buy me candy and sandwiches “medianoche” for mid morning snack.   He also taught me one time how to ride my bike, how to take a shower, and how to clean my shoes.  He was very particular about his personal belongings.


Now most of that is gone.  He can barely walk and is more forgetful.  He is in his late 70s and does not eat very much. He is retired and can barely take care of himself.  It’s almost like he has become a different person.   It makes me wonder,  what is happening to my Papi?

In spite of the changes, he continues to do certain things that shows glimpses of who Papi really is. He enjoys doing word search puzzles.   Papi sometimes still makes the kind of jokes he used to make.  He remembers most of his family members and friends.

I can’t help but to question again the reason for this existence.   The purpose of us living in this state of awareness we call “life” if at the end it is going to be gone.  My Papi was a jovial and active man.  Now he is a weak and serious old man.   Like the winter that comes and takes away all the beauty of the trees and the flowers and the sunshine, so does old age take away the sunshine that I often found in my Papi.   Will there be a spring after this?

Most of Papi is already gone.  Most of what he reflected has faded away.

I guess Papi is not completely gone.  At least not in my heart.

Sick of being Sick

 

I have bimageeen fighting something nasty for the last three days.. First I thought it was allergies.  Then I started getting chills at night.  And now  I’m just feeling like I am in a fog.   I take all kinds of medication.. They don’t seem to help much.

But I shouldn’t complain… A few days ago another one of  my uncles passed away (I have three gone already ).  I was not close to him at all, but my father was.   I just spoke with my father about him.   He said “he was younger than me,  yet he was gone first.”

I cannot help to think of the day that my father passes too.  I have been trying to accept it without getting too emotional.   But the day will come… it is inevitable.  And so will be the day that I am gone and every family member that I know … Because we’re not eternal.

So,  sick or not,  I will simply live this day.   Without complaining.  I may recover tomorrow.  Who knows?

What do you think?