Mental Photo Dump

I haven't written anything since 2019 for a few reasons: career burnout, transitions, and a variety of life events. I thought my muse packed up and left, that writer's block had taken up residency in my mind. Last week I saw a snippet of a Shonda Rhimes saying there is no such thing as writer's block, one just isn't writing. So this is me just writing to clear my mind.

The burnout: I love what I do for a living but it's heavy sometimes. Depression, anxiety, trauma, suicidal thoughts, people talking to you any kind of way, and management issues… Just when I started to turn things around along came COVID and the sudden transition to 100% telemedicine.

Transitions: Year number 4 of a 5 year financial/credit restructuring plan I was given 60 days to move out of the house I was renting because the owner wanted to live there. I just needed 9 months to meet my goals so a friend let me use an apartment for a couple months until a room remodel at my mother's house was completed. Did I want to be there after 19 years? Hell no. But was I going to meet my financial goal faster? Yes. Alright 6-8 months and I'll be out of there. Month 6 loan pre-approved and shopping for real estate. Month 7 mom had a stroke so I became a caregiver/house manager/hostage overnight. Yes I'm a nurse, but I stopped doing bedside care in 2004. That's all I'll say about that.

Life events:2020- Worked on a judicial election campaign. Served as co-chair for a women's wellness fair that got cancelled due to COVID. Mom had a stroke. Uncle had a silent heart attack. We lost a family member to COVID.

2021-Mom fractured her shoulder. My sweetheart had COVID. I was reaching breaking point, my cousin died, I regressed and did some DUMB stuff that damaged a friendship. Mom fell, fractured her femur (they initially missed it and sent her home), had emergency surgery, went to a horrid rehabilitation center (how you at a rehab and getting weaker?), and tested positive for COVID.

Some good stuff happened too, but I'm not writing about it today.

Mute Your Mama

DISCLAIMER: DON’T READ THIS IF YOU ARE TRIGGERED BY DISCUSSIONS ABOUT ABUSE AND SEXUAL VIOLENCE.

“I don’t understand why he wanted to hurt me. I was just a child”

These words spoken by a male patient echoed the sentiments of a myriad of my clients. Disclosures of past molestation, rape, physical abuse, and emotional abuse are frequently followed by a discussion of telling their mother or another adult only to have nothing done. In this age of increased awareness about sexual abuse we commonly hear about boycotting celebrities who have acted as predators. We see hashtags about muting people, yet they continue to receive media/social media attention. So why am I saying mute your mama? And when I say mama, I’m referring to grandmother, aunt, uncle, father, etcetera.

Mute your mama if she told you that it wasn’t nice to talk about things like that, instead of telling you it wasn’t your fault. Mute the people who didn’t want to believe that so and so would do something like that. Mute the person that made you move out of the house during your teens, and stayed with the abuser. Mute the people who think that abortion is wrong, made you hide your pregnancy resulting from incest, then took your baby away from you. You were 16 but your boyfriend was 23, mute the adult who thought that was cool. The person who didn’t pay attention to the fact that you suddenly went from being a happy child to one who was angry and looked empty, definitely needs to be muted. If you were told that you would be okay, and not allowed to talk about it: mute your mama. Mute the adults who knew that man was a pervert but somehow thought the next generation of children would be exempt from his abuse. Mute the woman who defends the man preying on boys….. SIDE NOTE: homosexuality is not synonymous with pedophilia. Mute yourself if you believe that. If you were raised with a children should be seen and not heard mentality which made you afraid to speak up, mute them.

These are the people who didn't protect children from further harm and are standing in the way of healing. I realize that parents can't be all seeing and all knowing, so I'm not blaming every parent with an abused child. But they are responsible for what happens in the aftermath. Children are left feeling worthless, confused, and not able to be successful in many aspects of life (jobs, relationships, self worth) because people silenced them. They carry secrets and pain into adulthood until it derails them, and they seek help as a last ditch attempt to save their lives. Then it's recommended that we screen for ACEs (adverse childhood experiences) and find ways to build resilience. But wouldn't it be better if they didn't have to cope with these situations to begin with?

Lastly one set of folks who need to speak loud and clear so everyone can hear them: the abusers/predators. Do they do disgusting things? Yes. Should they be punished? Absolutely. I don’t always agree with labeling them “a monster”. Sadly many of them were once victims too: people in their lives needed to be muted. If we don't know what corrupted their brains and morality, we can't figure out ways to stop abuse from happening.

Putting My Business In the Street

“Life can be only what you make it. When you’re feeling down, you should never fake it….”

Mary J. Blige-My Life

I haven’t written anything for a few months. Multiple reasons come to mind, but the most basic explanation is this: I didn’t feel like it. I mean, it’s not like I get paid to do this and on average only 50 people will read this. But I had to really look at my situation and realized that I was approaching burn out.

There are articles that talk about provider burn out. Meaning we get so overwhelmed by our jobs that some of us lose our passion and motivation for the work, become depressed, anxious and suicidal in some cases (NOT ME, thank goodness). Providing direct services is what I enjoy most, but I was thinking about going back into a management position (LOL). I had to figure out how to deal with several issues that were making me feel the way I felt.

1. I got tired of being Black. No, I haven’t lost my mind. When you’re only one of a few at your place of employment it can be tiring. I’m the only Black person who performs a certain function at my job, so when people request a Black provider it’s me. And most days I’m okay with it, it’s one of the reasons I chose to work in mental health. I LOVE MY PEOPLE. But every now and again it saddens and angers me that people continue to experience multiple forms of discrimination on a daily basis, especially since I deal with it myself (dog whistles are LOUD AS HELL!!!). I laugh at an interaction that happened during a meeting which I attend on a regular basis. After one year I was appointed as chairperson of a subcommittee, which meant that I became a co-chair of the larger group meeting. When I was being introduced in this role a woman interrupted with a voice full of excitement, she asked if I was the new administrative assistant. Of course I smiled really big and giggled as her face turned fire engine red when she received the correct information. But back to the care experience. A lack of training on ways to actually use cultural competency information sometimes results in Black people being misdiagnosed or having delays in treatment, so I have to work with people to repair their lack of trust in the system. The other “fun” scenario, I get cussed out for not helping my people. I’ve called a racist because I wouldn't approve an unnecessary treatment. So yeah, I was tired of these aspects of being Black.

2. I’m human. I got tired of being disrespected. Providers are people too. It sometimes seems that our patients and colleagues forget that. On an almost daily basis I receive e-mails from people who call me incompetent, unprofessional, and uncaring. Typically this come in response to my not doing something that they want. I’m blamed for medications not working. My education and expertise is questioned/challenged by patients and colleagues. Some assume that I don’t have many years of experience based on my appearance (I look younger than I am). For example, the patient who requested a new provider and specified wanting someone with more than 5 years of experience (I guess 14 years wasn’t the right number either because that’s what I have. HAHAHA!). Then my dear colleagues whose mission is to exclude NPs. They send me condescending messages, talk to me like I’m stupid, or feel more comfortable discussing my patients with my colleagues instead of speaking to me directly. For whatever reason there’s the belief that as healthcare professionals, especially mental health professionals, somehow wear a shield of armor that protects us from being affected by this type of treatment. God forbid we respond to it at the risk of someone filing a complaint. Every 2 weeks hush money is direct deposited on time into my bank account. So I take a deep breath and keep on pushing. But one can only imagine what types of responses run through my mind. How would you feel if this was part of your job on an almost daily basis? When a patient simply says thank you, it goes a LOOOONG way.

3. Disorganized systems. “Just Do It” is not a slogan for all situations. Where is the implementation plan ? How will changes affect workflow? What is being tracked? Is there a quality improvement process going on? Etcetera, so on and so forth. I stopped biting my tongue and found ways to give constructive feedback.

My “simple” approach to fixing all of this:

1. Thank You Jesus! Yes, “I curse a little but I love the Lord”. Prayer and spirituality keeps me sane. I truly believe that I am doing what I was born to do. Nursing is my calling. Seriously, my license saves lives in more ways than one.

2. My Life is Good:.Thankfully my life outside of work is solid. I have people who love me, and catch me when I feel like I’m falling. I have positive things to keep me busy. When all else fails, cleaning like a tweaker gives me a sense of calm. Taking vacations and mental health days with good people make a difference.

3. Music soothes a savage beast. It all depends on my mood. It may be Coltrane, the Winans, Brian McKnight, Lenny Kravitz Snoop or Bishop Bullwinkle that gets the job done for me. Last week I wore out Lil Duval. Just had to smile, couldn’t go back and forth with ……….!

War. What is it Good For?

“The older I got the more I realized that grandma wasn't just full of Christmas cheer, she wasn't just happy: Grandma was high! Seeing her medicine cabinet as a teenager was like discovering Shangri-La".

DISCLAIMER: THE MAJORITY OF THIS IS NOT PERTAINING TO PEOPLE RECEIVING TREATMENT FOR PAIN.

The so called War on Drugs wasn’t successful at accomplishing much except for the incarceration of black and brown people in disproportionate numbers. “Just say no”, wear a red ribbon for a week and focus on telling kids how bad drugs are, and run ads about your brain on drugs. Whatever, people kept using drugs and getting high. I once had someone tell me that they didn’t sell drugs, “drugs sell themselves”. People are abusing Immodium for crying out loud because they want to get high. And why was it dubbed a war on drugs? Why the adversarial stance against people using drugs? Society traditionally viewed people who use substances as outcasts, but now demonstrates compassion for people "forced" into addiction by clinical providers. This started in the 1980s, yet the US is still trying to figure out ways to prevent drugs from crossing our borders. It seems that it would’ve been more helpful to declare war on the lack of resources to treat underlying conditions that make people want to use drugs. 

Opioid crisis, #crisisnextdoor. The current US Surgeon General speaks to the need for increased funding for services to provide integrated treatment, including mental health services. Yet it seems that his sound logic is being overshadowed by the emphasis on the Opioid Crisis and access to Naloxone (Narcan). Please don’t misunderstand me, increased access to Narcan for overdose prevention is necessary. But let’s not loose sight of the real issue: prevention (and reduction) of use and overdose to begin with. In my experience, over 90% of the people I’ve treated for substance use had a diagnosable mental health condition;  people self-medicate in an attempt to feel better or to block out painful memories. This is where the word “treatment” becomes hazy. When they mention increased access to treatment as part of the solution to the current crisis, what exactly do they mean? True, many substance abuse programs provide mental and physical health services, but there are still some that don’t. And how are we increasing access to services amidst an attempt to cut funding for healthcare for those who have difficulty affording care?

And why are we wasting money trying to sue Big Pharma. "Why are they still making these drugs?" Because some people actually take them as prescribed to treat pain. People like to throw the term Big Pharma around in a negative manner without looking at the full story: they have been attempting to make medications that work as intended but with safeguards to prevent inappropriate use. Take Oxycontin for example. The manufacturer developed a version with a coating that couldn’t easily be crushed or dissolved for snorting or injecting. People tried it anyway, experienced adverse effects, and then wanted to blame the manufacturer. I’ll provide a more basic example:Tylenol. People took more than the recommended dose and experienced problems with their livers. You can’t buy the 650 mg strength anymore (part of the reason Vicodin is dead, Norco has less Acetaminophen/Tylenol). So is this Big Pharma’s fault or do people need to be held accountable for using medications incorrectly?

I encourage people to read about the Sunshine Act and Anti Kickback statutes regarding monetary incentives for prescribing (sorta boring but good information). It’s been over a decade since companies were able to provide items with logos or drug names on them. So I really need people to stop acting like all medical providers are so easily swayed by lunch or a few free trinkets that we are able to get at conferences. The overwhelming majority of us don't get paid for prescribing drugs. Or did they put my million dollar check in someone else's box? Anyway, when drugs are taken off of the market we end up with synthetic drugs which are more lethal in most cases.  And clutch my pearls! Suburban use of heroin is on the rise (I guess it’s a gentrification proof drug). Let’s pay attention to it now because people with money are using poor people’s drugs. But with most of the focus being on opiates and ads against underage use of tobacco, is everyone else unimportant? What about alcohol, cocaine (powder is popular again), meth, marijuana, nitrous oxide, ghb, shrooms, etcetera so on and so forth? Oh yeah, FLOTUS is on her job to help children Be Best by telling them to not use drugs and be resilient.

Say Yes to Sex!

A couple of months ago I read an article reminding professionals to ask about sex during assessments for bipolar disorder, which I do routinely. In my book I shared a few quotes about sex and my experience of discussing it with clients. But in the big scheme of things, people have a hard time discussing it. So yes, I'm talking about sex today.

First of all, it's difficult for me to understand how sex became something dirty and a taboo topic in some cultures (I'm being facetious, but this blog would be too long if I went there LOL). The reality from a biological standpoint: our bodies were made to have sex, it's how we reproduce. Our "private" parts have extra nerve endings so we can experience intensely pleasurable sensations. ORGASMS ARE AMAZING! Yes, sex is supposed to be enjoyable. And everything ain't for everybody. There are different strokes for different folks. A variety of things turn people on: hair color, body type, hot wax, whips and chains, fetishes, different positions, and so on.  Too often people are called freaks, perverts, nasty, or sick(although in some cases they are) because others view the world rigidly using their moral compass. Now we have a culture where people don't talk about sex enough; even with media being saturated with sexual images and content. Sadly many people still think their belief that children shouldn't be having sex is justification for not talking to them about it. As if just saying no was ever an effective tactic (did red ribbon week stop the crack epidemic?). Not talking about it can result in unwanted pregnancies, sexually transmitted infections (including HIV), and risky behaviors (for example thinking that anal sex is better than vaginal sex because it maintains virginity and or prevents pregnancy). They're going to do it anyway, they may as well be informed; might have to inform yourself in the process. Young people need to feel comfortable and safe talking to trusted adults about sexual situations. And please give them unbiased and accurate information about birth control and options for terminating pregnancies. Having an abortion will not damage the uterus (I'm annoyed when I hear that). "My mama said....." is often part of the explanation I hear when someone explains why they made certain decisions about pregnancy.

Sex is part of intimate relationships. During a conversation with a friend, he shared that men sometimes feel uncomfortable talking to women about sex and think that there's no need to ask about what she likes; does she like what he's doing? He went on to explain that a common perception is that a woman's willingness to repeatedly have sex means that everything's cool.  Now let's look at the other side of the story. Women are made to believe that it's shameful for us to be comfortable with our sexuality. Some don't feel that they can say what they like without being judged. A patient once told me that she didn't feel like she could tell her boyfriend to use a condom because she thought it would upset him. Lack of satisfaction has ruined many partnerships, but simple conversations may have saved them. One never knows, trying something different may be fun. A conversation can take the anxiety out of a sexual encounter. If you know that your body works differently and talk to your partner ahead of time, it can prevent them from thinking that they're doing something wrong. Sadly, I've encountered sexually active women who have never experienced an orgasm. Beyond that, some don't even have a real understanding of how their reproductive system works. That being said, they don't know how to let someone know when things aren't right. Which leads me to sexual dysfunctions.

Ladies and gentlemen. If it doesn't work right please speak up. Talk to your partner and or a healthcare provider. There are soooo many different things that cause problems, but there are solutions for most of them: difficulty becoming aroused, difficulty staying aroused, aroused but can't have an orgasm,  performance anxiety, painful sex, and the list goes on... One of the most interesting diagnoses I've seen is Headache Associated with Sexual Activity. What's more embarrassing having equipment that doesn't work, or talking to someone and getting some help? All treatments are not medications. Sometimes we recommend different techniques, therapies, devices, lubricants, masturbation (does it work alone and just not with others?), condoms, and exercises. Sometimes issues are a side effect of medication or related to a physical health issue (diabetes, high blood pressure). So at the end of your visit when you're asked if there's anything else that you'd like to discuss say yes, and talk about sex.

Stop it.

May is Mental Health Awareness Month. I planned to write about a few topics.  My mind was filled with thoughts about culture, womanhood, stigma, and other factors which impact an individual's mental health. Then along came the AHCA debacle interrupting my thought process. Insert my mini rant about the current political climate. Simply stated: our president is bad for America's mental health. The new PTSD (google Post Trump Stress Disorder) is REAL. Some people's health has declined, relationships have been damaged, and many are fearful about their ability to access care on an ongoing basis. Proposed policies and budgets demonstrate a lack of concern for citizens' well being. This needs to stop. It's hard enough as it is for people to access services.

Every day I encounter people with stories of suffering in silence. Middle-aged women abused during childhood, yet learned to act like it didn't happen. Men who get into altercations with co-workers and call in sick multiple times per month because they're too depressed to function. Young adults complaining that something was "wrong" for years but their parents didn't believe in getting psychiatric treatment. They interact with people on a daily basis, but no one tells them to get help until their symptoms are severe. Why do people continue to treat mental illness like a taboo topic? Tell your mother, brother, son, cousin, friend, or coworker that they don't seem like their usual self. Let them know that you're concerned. Please stop ignoring what you see and hoping that it will magically resolve. Stop telling people that they will be alright when they say they're stressed or depressed. Encourage them to get some help. If someone tells you that they have chest pain, do you tell them they'll be alright? No, you tell them to go to the hospital. Believe it or not many people are relieved that someone cared enough to say something, or feel relieved that they were able to talk about what is bothering them. Sometimes they don't even realize how severe their symptoms are until someone lets them know.

So now that we've cleared that hurdle, a person makes it to an appointment. They may receive recommendations for therapy and or medication, and things such as eating a healthier diet and increasing exercise (yes, mental health providers care about this too). Please stop telling people that you think the diagnosis is wrong, or that they shouldn't take the medication because of something that happened to your sister's best friend's cousin.  There is way too much information available for this foolishness to continue (just thought of something else that needs to stop). I've had people tell me that they don't want a certain diagnosis because "that's serious", or "people with ____ are really crazy". Insert stigma and media reinforcement of mental health myths. What do I mean by this? in general, people act like mental illness has to be kept a secret. People come in without knowing their family history, because no one wanted to talk about it. Grandma was "crazy" and committed suicide, but no one knows what she had. But here's a person being encouraged to get treatment, because they're acting like grandma. It is almost without fail that a disclosure about someone's untreated psychiatric diagnosis follows news of mass shootings/acts of violence. "Sources reveal that the shooter received treatment for depression in the past..." Really? And I'm really curious about the "sources" of such information. Who are they? A negative image is painted when celebrities are hospitalized. Remember what happened to Kanye? Believe it or not, people refuse to accept diagnoses or base their understanding of symptoms on these images. This needs to stop.

Stop posting things about alternative treatments and negative information about medications on social media without checking the source first. Some of these people who call themselves experts are not. Some people hold the title Dr. because they have a PhD. or other doctorate degree, so it doesn't necessarily mean that they have medical/psychiatric credibility. And there is no medical establishment conspiracy to kill people with medications or keep people sick so we can make more money. The last thing I think needs to stop (at least for now): this blog post. 

I wrote a book because people told me it was a good idea

In April 2013 I started the process of making a coffee table book. I planned on putting together a collection of quotes and photos. I came up with a rough draft, asked someone to review it, started researching the self-publishing process, then I let it sit. For at least a year. What can I say? A LOT happened during that year, I gave in to fear and wondered if writing a book was really something that I wanted to do. People kept asking me about the book because they were looking forward to reading it. Darn positive peer pressure!

I reopened the rough draft and started making occasional revisions. Then felt the book needed more substance, but didn't want it to be too technical or academic. I decided to make it fun, insightful and informative. A quick tangent: writing a textbook chapter is easier because it involves a set topic, established facts, formatting guidelines, and a deadline for submission. My book became an emotional process and a segue way to a period of self-reflection. I spent a decade at a job and arrived at the realization that it was the only constant in the midst of many life changes during that time period. Needless to say, I had to walk away from the book for a few days sometimes to refocus. Fast forward to December 31, 2016. Who sits in the house on New Year's Eve working on a manuscript, drinking champagne, and listening to loud music? This woman!

Now I'm in the "fun" phase of this project. 2 editors and multiple revisions. Decided on a concept for cover art, then changed my mind. Conducted a survey to determine a book title, then came up with something totally different; I joked with my editor that the title would be "Esker-D wrote this book because everyone asked her to do it". I laughed at the actual page count considering all the time spent working on it. Oh well, room for improvement. Scheduled an appointment with my photographer, and received a crash course in marketing: need a website, consider psychographics, the book can't be the end game....WHAT DID I GET MYSELF INTO? Just a few quick comments about my branding session: I don't like shopping for clothes and don't wear a lot of makeup (both things that I had to do) but love taking pictures. My session was amazing and ended with an impromptu video to promote the book. 

The book is 98% complete (missing the cover HAHA) and should be available for purchase in a few weeks. The new title is Dirty Sidewalks and Beautiful People. If you're reading this as one of the many people who encouraged me to write this book, you better buy a copy.