Date Tags help

That you're only working for yourself because you think you're too good to have a normal job like everyone else. You will hear it all. There will always be an opinion lurking around the corner and it will come from a person who's inexperienced, unmotivated, and all talk and no action. Don't let petty words and criticism influence your habits and decisions. As some know, I am fond of the history of gunshot wounds, which aptly demonstrates primum non nocere--first, do no harm. Back in the fourteenth century, battlefield surgeons abandoned an ancient, safe approach to treating wounds, especially gunshot wounds, and began pouring boiling oil into the open lesions. The earlier practice, dating back to the Egyptians, of gentle wound care by removing debris, carefully washing with water, and covering the wound to allow natural healing was replaced by filling it with boiling oil. This unsafe and disastrous practice persisted for two hundred years, until one day no boiling oil was handy for the surgeons. They resorted to the ancient technique and discovered that gentle, safe care was clearly superior. This story reminds us that every treatment needs to be as safe and as gentle as possible. Safety in treatment pertains not just to medications but to individual and group therapies, to nutritional approaches to well-being, and to the day-to-day communities of people and the environments in which people with substance-use problems live. Monitor and alter your breathing. As we saw above, hyperventilation is a major physical cause of panic attacks. Because they are breathing so quickly, people who are hyperventilating are expelling carbon dioxide through respiration faster than they can replenish it. This, in turn, causes them to feel as if they can't get enough air, which causes them to breathe even faster, making the problem worse. The good news is that by simple practices of breath control, you can quickly lower your anxiety levels, bring down your panic, and eliminate hyperventilation. Remind yourself to simply try breathing slowly and deeply (not through shallow chest breaths, however, but through deep, belly breaths - discussed above - known as diaphragmatic breathing). Ideally, you should aim for about six breathing cycles a minute. If you have reached this rate of slow breathing, your panic and anxiety levels have probably also been significantly lowered as well. You can try taking out a stopwatch (either a physical one or one on your smartphone) and counting the number of times you breathe each minute until you get down to only six respiratory cycles (inhale and exhale) per minute.

Distract yourself, talk to someone near you, call someone on the phone, play a game, or something else to take your mind off the attack. You may be thinking in response to this - "how could I possibly talk to anyone else or do anything else? - I'm panicking!" Just remember though what we said above. Your panic is not visible to others, even though inside you, it may be the most important thing that's happening. Moreover, you are more in control of your behavior than you think you are. Even in the midst of a panic attack, you are actually still consciously controlling your external actions. Therefore, try a few simple activities to distract yourself from your feelings of panic. The purpose of doing so, it is important to note, is not to "shut down" your anxiety. As we have seen time and again, forcing yourself not to panic goes nowhere. The purpose, rather, is to find a way to stay grounded in the present. Panic preys on the inescapable truth that the future is unknowable. While we can predict certain things fairly well, there is always an element of chance in human life, and we cannot know everything that is going to happen to us in advance. This is why the future can be scary. The way to halt or mitigate a panic attack, therefore, is to return one's focus to the present and to realize that nothing scary or dangerous is actually happening in the here and now. My difficulties in being able to focus on just one task led to all sorts of problems. One example of this was the piles of papers that grew in various places in my apartment. The largest of them sat on my kitchen table, while smaller piles on shelves resembled birds' nests. These piles were made of all sorts of things, but many of them consisted of items plucked from my wallet: store receipts, cash machine receipts, fast-food coupons, and names with telephone numbers jotted down on scraps of paper. Besides that, the piles also contained a good deal of unopened mail, like bills and bank statements, plus restaurant menus that had been slipped under my door and hastily scribbled notes that I hadn't yet dealt with. It was those handwritten notes that were my greatest cause of frustration.

How could I have so many of them, what should be done with them, and where should they go? Where did they come from? What do I do with them all? Which do I keep and which should I toss into the trash? What if I threw out something I should have kept? All these questions, plus my lack of answers, caused terrible feelings, such as bewilderment, confusion, fear, frustration, and anger, within me. That last emotion, anger, was the one that bothered me most, because I wasn't terribly certain if my anger was directed at those bothersome stacks of papers, or at myself. Each time I glanced at them, they almost seemed to eerily communicate back, mocking me. Sometimes, I'd make a half-hearted attempt to take action upon them by combining the smaller piles into one large paper mountain of sorts. Of course, just one look at this staggering heap was too much, and I'd quickly walk away from it and do something sensible, like turning the television on. For me, this mountain awaiting action became something of a "Memorial to an Unknown Adult." When you're on your path and drama, conflict, and problems arise, imagine coming to a fork in the road and having the option of taking the path of negativity and drama or the path of avoiding it altogether. Most people choose to engage and get involved and it causes a lot of negativity and unhappiness. It causes a lot of preventable problems. You have a choice every single time. You can choose to go down the path of peace of mind rather than the path of drama. You can choose to separate yourself from petty nonsense, drama, and conflict. Many engage in negativity because they're bored, in the wrong environment, and they don't have goals to keep them busy and moving forward. They don't have anything to remain focused on. When talking about negativity, my brother, the same one I've talked about twice in this book, says, "Negativity, to me, is like radio static. On the older radios, you had to keep turning a knob until you found a clear station you wanted to listen to.

In between the clear stations, there's a bunch of radio static that isn't pleasant to listen to. When I hear something negative or someone's talking about something that I don't care to hear about, it sounds like that ugly radio static. I don't listen to it. I just turn the knob until I hear something that's worth listening to." When I'm talking to someone and they start getting shitty with me, I tell them we will continue this conversation another time when they can calm down and learn how to talk to me correctly. If someone is arguing on the phone in my home, I ask them to step outside. If people get into a fight and it has nothing to do with me, I separate myself from it until they hash it out. 100% of the time, I consciously choose to take drama and conflict-free route. It preserves my peace of mind and keeps me happy. This means that care must have at its core the value that patients can be their best advocates and agents and should hence be engaged in what is called shared decision making. Dr Pat Deegan was an originator of this approach and continues to shape our field. Collaborative care recognizes that all chronic illnesses are best managed when the patient, and family, when possible, are fully engaged as active partners in treatment. In Born to Run, Bruce Springsteen's autobiography, we come upon a second book dedication late in this 510-page personal odyssey, penned by one of the greatest musical spokespersons of our time. Springsteen's father was an alcoholic, prone to violent outbursts. While Springsteen himself has been free of substance-use problems, he has suffered many severe bouts of depression. He writes about his long-term treatment for that disorder in this book. The Boss (as he is known) tells the reader, "The results of my work with Dr. [Wayne] Myers and my debt to him are at the heart of this book." "Doc" Myers was Springsteen's New York City psychiatrist and therapist from 1983--when the Boss faced "bramble-filled darkness" and a stubborn feeling that there would be no exit--until shortly before Myers died in 2009. In 1983, Springsteen would soon achieve fame and fortune. But these don't make for happiness and are poor anodynes to depression and hopelessness. Springsteen writes that Myers "guided me to the strength and freedom I needed to love things and be loved." For many years Springsteen's treatment worked, but that did not keep him from relapsing into depression when he turned sixty.

But he had developed trust and confidence, a sense of how a doctor and patient can work together, found another doctor, and recovered, slowly, over a number of years. As a psychiatrist, I cannot think of a finer testimonial, unsolicited and authentic, to my field and to those patients (and families) who work to overcome a mental or substance use disorder. Springsteen's treatment was surely collaborative, and he stands as an example not just of musical greatness but of human frailty, as well as resilience and recovery. Other specific ways to stay focused on the present. Let me offer an example that I use to help manage my fear of airborne turbulence during a bumpy plane ride. It used to be the case that I felt very helpless and frightened when a plane entered a patch of turbulence. Each time the plane would go over a bump, my thoughts kept leaping toward the unknowable future. "What if the next bump is even bigger?" I would think. "What if they just keep getting bigger and bigger and never stop? What if it's just like this for the whole rest of the flight?" A helpful technique I learned through cognitive behavior methods is to focus on each bump as it happens, not on hypothetical future bumps. When a bump goes by, try to rate it on a scale of 1 to 10, with 1 being a minor bump, and 10 being the most frightening bump you can imagine. You will quickly see that the worst bumps you imagine never come, and a surprising number of the bumps you used to find so scary in the past are actually now in the 1 to 2 range. I have been playing this game for years now, and have flown all over the world on numerous plane rides, and I don't think I've ever ranked a bump higher than 4. A very similar method applies to manage all forms of panic. Instead of focusing on anxious thoughts of "how bad might my panic attack get in the future" - which you can't know because this question has no knowable answer - focus instead of ranking the level of fear you are actually feeling in the present. You might even try the 1 to 10 "scoring" game, trying to rank each wave of panic as it comes to see how bad it actually is. Chances are, you will find that you never rate anything very highly, because you have already trained yourself not to focus on the key driver of panic - the unknowable future - but to stay with the present, where you realize you are in fact perfectly safe. This 1 to 10 "scoring" technique was invented by Dr. Martin Seif - a psychotherapist who specializes in treating fear of flying through cognitive behavioral methods - and he recommends it as a simple way to stay anchored in the present. One evening, full of self-loathing, I confessed this inability to function normally to a neighbor.