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Episode 4: Self-Care: More Complicated Than It Sounds
93 Plays4 years ago
Drs. White and Brenner discuss self-care, compassion, and the promises and challenges of cultivating a deep and fulfilling relationship with yourself. Treat yourself right and others will treat you right, too.
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Transcript
Introduction to Doorknob Comments
00:00:17
Speaker
Welcome to Dornoff Comments. I'm Dr. Farah White. And I'm Dr. Grant Brenner. Thank you for joining us on Dornoff Comments, a podcast that we created to discuss all things involving mental health. We take the view that psychiatry is not just about the absence of illness, but rather the positive qualities, presence of health and strong relationships and all the wonderful things that make life worth living.
00:00:39
Speaker
The show is named for a phenomenon that sometimes happens at the end of a therapy session when the patient may mention something important or something they're conflicted about right as they're walking out the door. Sometimes they may have been quietly thinking about it the whole session without saying anything at all. Equal parts frustrating and intriguing. It leaves the therapist holding the emotional bag.
Why is Self-care Important?
00:00:59
Speaker
Today we want to talk about something that's important to all of us all the time, but especially important right now in these troubled times. Grant, do you want to say a little bit about
00:01:11
Speaker
Well, I think we're talking about self-care and I guess implicitly it's also about community and about other people either know how we take care of other people and how they take care of or don't take care of us. I think today we're going to focus on one's relationship with oneself and certainly the COVID-19 coronavirus
00:01:38
Speaker
activity has got everyone on the planet paying attention in a way I think maybe we never have before.
00:01:50
Speaker
I'd agree with that. And I think one of the biggest issues really is that people don't seem to have a lot of guidance on what to do and how to do it and can be a time of great stress. So maybe this can be sort of grounding and allow people to continue to do what they need to do to take care of themselves.
00:02:14
Speaker
Yeah,
Self-care in Uncertain Times
00:02:15
Speaker
certainly. I mean the context is kind of interesting because if you think of self-care as requiring a degree of self-guidance, self-governance, self-parenting, sometimes people use that term, self-compassion certainly depending on your attitude.
00:02:33
Speaker
The political and global climate is very strange. We have this coronavirus thing and we'll get back to individuals in a sec. But there's not a lot of trust in leaders. You have the president of the United States appears to be
00:02:50
Speaker
cognitively impaired. Well, I was going to say not following the best risk communication principles and essentially spreading rumor. If you look at risk communication, you're supposed to give good information. You're supposed to help soothe people. So who do people look to for good executive function? And it's almost like if you're in a dysfunctional family, like the parents are fighting, like the CDC is saying one thing, the president is saying another thing.
00:03:21
Speaker
Yeah, and it's very anxiety inducing, I think, for everybody. Right, and these are times when you want to take appropriate steps based on good information so you can take care of yourself and the people close to you. Of course, if you're in good shape, you can take care of people around you better. And the temptation is to succumb to panic.
00:03:45
Speaker
Obviously, we see a lot of panic buying, which is a way for people to feel like they're doing something to be prepared. There's a lot of disinformation. How does that apply to kind of any time? Because life always has periods of stress.
00:04:02
Speaker
Okay, so let's talk about on a more general level, what are the things that we want people to know about self care? I think the first thing, the point that you brought up is that it's more than just having good sleep hygiene and exercise habits, that it's a state of mind and an attitude towards oneself. Can you say more about that?
00:04:24
Speaker
As I see it, it does require a lot of executive function and intentionality. The kind of the research on change and coaching, you know, if you look at what actually helps people get where they want to go, it's knowing the path you want to take and feeling able to take it. For example, there's some work with like who gets PTSD and who doesn't and researchers looked at hope and optimism and they were talking about hope as knowing
00:04:51
Speaker
the steps you need to take and feeling like you are empowered to take those steps, optimism more being kind of a general faith that things work out right and optimism was protective but hope was more protective.
Approaches to Effective Self-care
00:05:05
Speaker
Having a specific plan, good information, a sense of where things are supposed to go.
00:05:11
Speaker
how things are supposed to go, what you need to do, feeling self-efficacy to do it. And I think people lose sight of that when we're anxious and filled with uncertainty or higher mental function goes out the window. So self-care for me, a lot of it is
00:05:27
Speaker
being, you know, staying at the helm, not giving up control. Yeah. And then the other part was that you brought up was really where it comes from, that it doesn't come from discipline or self-criticism, but that it comes from a place of compassion, acceptance and love.
00:05:46
Speaker
I don't know if you can really link that to what you were just saying but one of the connections that I can see is that for people who
00:05:59
Speaker
know that they might be prone to, I don't know, slip with those healthier habits. What can they do when they're feeling kind towards themselves to make sure that in the harder moments, the self care doesn't go out the window.
00:06:17
Speaker
I think they are connected and control is not like a harsh rigid thing like a parent who shames you or tells you why aren't you better.
00:06:30
Speaker
And it's not being over-controlling like being perfectionistic or, you know, quote unquote OCD and trying to control everything. It's about accepting uncertainty. And if you give yourself gentle guidance, then you give yourself permission to mess up and come back to what you wanted to do in the first place.
00:06:51
Speaker
I think when people get into a blaming frame of mind, they're more likely to get distracted from what's important and so it's like a gentle but firm self-guidance that comes from the heart.
Mental Health Challenges
00:07:06
Speaker
And the other thing that I want to bring up about self-care, because I see this a lot in practice, is that there are things that can really interfere with our ability to care for ourselves. And things like depression, anxiety, and trauma can make everyday habits like showering, brushing swan teeth, even getting up out of bed to use the bathroom,
00:07:31
Speaker
can be a challenge for someone whose emotional state is really struggling. What do you usually recommend to people if they're so depressed and so anxious that they're having a lot of trouble pulling it together?
00:07:47
Speaker
So I recommend usually that the treatment is that that's one of the things that I look for actually when I want to see how someone's doing. A lot of times like with new moms it's really really hard to find time to shower.
00:08:03
Speaker
And if days go by and she can't find the will or the time to wash her hair, that's something that she may need a little bit more support with. And I think that for whatever reason hygiene habits, which vary a lot by culture and background, people seem to not be that compassionate.
00:08:31
Speaker
What do you mean? Like society doesn't really tolerate people who smell bad or look disheveled. It can be tough to be in this world if you can't maintain a certain level of grooming. Yeah. Would you agree?
00:08:54
Speaker
Yeah, it can be certainly, you know, women get a lot of flack for things like that and men do too. They say the clothes make the man. But I'm imagining the mom you're talking about and I'm wondering kind of how was she raised, was appearance excessively valued? And so is it going to be more likely that she'll start to
00:09:18
Speaker
get on her own case in a very nagging way if she's having a little bit of trouble. Or is she going to say, well, it's really tough being a mom. It's okay. And does it help a person to make a decision after a couple of days of not showering as much as they think they should?
00:09:40
Speaker
to be kind to themselves more than it does to give themselves a harsher time. Because sometimes people respond to kind of harshness, but even though maybe she ends up bathing and brushing her hair and stuff,
00:09:56
Speaker
On the inside, she's still feeling like maybe she wasn't good enough. I'm wondering what your thoughts are about that versus kind of feeling like grateful to herself and building over time, you know, gratitude rather than kind of doing what you're supposed to do and feeling resentful toward yourself on
Cultural Pressures and Self-worth
00:10:14
Speaker
the inside.
00:10:14
Speaker
I think the motherhood example is a tough one because as much as new moms are expected to have a baby, look great, bounce back, and kind of do it all, they're also expected to breastfeed and get up at night and really self-sacrifice for the purpose of a newborn.
00:10:40
Speaker
I remember I was reading about love and attachment and you remind me of something I came across which showed that like caregivers, moms as well as I think certain clergy people, they literally didn't feel their own pain when they were in a caregiving mode like the chemicals that are related to bonding like oxytocin and all the stress hormones made it very easy to sacrifice oneself
00:11:06
Speaker
And of course, that kind of makes sense evolutionarily. But on the other hand, you don't want someone like a mom to be so self-sacrificing that she's no longer capable of taking care of her baby, which you see with postpartum depression and other things like that. Right, exactly.
00:11:23
Speaker
I think the more, let's try to think of another example that's like a little bit more mainstream and may not pertain to such a small population at such a difficult time.
00:11:38
Speaker
Well, I think we all are prone to do this. I shouldn't overgeneralize, but okay, in a place like a major urban center like Manhattan, a lot of people are working so hard. They're working to live rather than living to work, which is the right one, are you supposed to do? Working to live, right? You're supposed to work to live. They are living to work. Yeah, they're like workaholics.
00:12:04
Speaker
Why do people do that, do you think? Why do people kind of lose sight of what's important in life? They live for a sense of being productive rather than maybe a sense of meaning and purpose that's more internally driven rather than externally driven.
00:12:20
Speaker
I mean, I think a lot of, especially in this tri-state area, people are programmed to believe that perfectionism and academic achievement, and maybe we're talking about also a certain cultural background, but that kids are taught that they need to perform. And that means academically, that means in terms of extracurriculars, that means in terms of looks,
00:12:49
Speaker
So, like psychoanalytically, do you think that suggests that the way they've internalized the, like, inner parent is that if they don't perform according to these external standards, then they're not valuable and loved? Correct. And so, adopting, shifting to a more self-compassionate stance is something like learning how to be as if you had had a loving parent who
00:13:13
Speaker
who cared how you did, of course, because it is important, but who didn't make it the center of who you were to them. Right. And I think that unless people believe that their health and happiness and pleasure should be paramount, it's really tough to convince people to take a day off or a week off.
Role Models in Parenting
00:13:37
Speaker
So, I've shifted into another sort of mode that says like, okay, well maybe you shouldn't pull back just for your own sake, maybe pull back for the sake of your brain and the sake of longevity of your career because there's a lot of research that shows that people need to not necessarily work harder but work smarter.
00:14:01
Speaker
and sleep properly and eat properly and you want to live a long and happy life, not a long and miserable life. What I thought you were going to say is that also for the sake of their kids because parents are like a role model and if you have kids and you're never home because you're working all the time or you're miserable because of work in front of them all the time, you're not really there as a parent.
00:14:29
Speaker
at least in an extreme, you know, there's a lack of family. True, but I think in some parts of the world, the pressure to have your kids play soccer and instruments and the pressure to support that. At the same time, soccer and instruments, because you could probably play violin and soccer at the same time, I'm thinking. Right, but you could play baseball and piano.
00:14:57
Speaker
But you could play baseball and you could play a foot organ probably. I mean while you're batting, maybe while you're waiting at the base. That's a joke about how wacky it gets, right? Like it's over prescribed, over subscribed. Over scheduled. But I still think what people see their parents doing is important. And if you don't see your parents sort of taking care of themselves, then you think, well, that's what you're supposed to do.
00:15:27
Speaker
You're supposed to sacrifice too much or not care about what's really important. I remember this reminds me, my father worked very hard, you know, and six days a week for 42 years in the family business. And he would often talk about a dream he had that he never realized. And that dream was to buy, I think it was to buy a convertible, which he could have bought a convertible, but he would always kind of go,
00:15:57
Speaker
It's not really important, and I'll drive it around a little bit, but it's okay, kind of. You never got one? No, you never got a convertible, no. So sad. They're not safe anyway. True, but still.
00:16:17
Speaker
Yeah, and if you have a comb-over, it's definitely out of the question. Do you rent one, at least, here and there? I'm not sure. I'm not sure. I'm not sure. But he was a child of the Great Depression. And so, you know, some of these problems, listeners might say, well, that's sort of a first-world problem. I thought that's where you were going earlier. Like, if you have to work to survive, then that makes a lot of sense. But a lot of times, it just becomes the default. Yeah.
00:16:44
Speaker
generation after generation. But I think this is also why they talk about stuff like lifestyle inflation because a lot of people as they work harder, things feel more and more out of reach for various reasons.
00:17:03
Speaker
Yeah. I think you could make a case that some of that is like the transmission of the deprivation of the sort of immigrant generations down the generational line, what they sometimes call post-traumatic or intergenerational transmission.
Generational Wealth and Self-care
00:17:21
Speaker
It's like the mentality gets passed on and then sometimes you see the flip side which is kind of like
00:17:29
Speaker
total lack of any kind of purpose. I was reading that a very wealthy actress, maybe, I forget who it was, but oh, it was, I'm blocking on their names, the popular singing family from the 70s and 80s from Utah. I don't know. Wow. Partridge family.
00:17:57
Speaker
Yeah, the Partridge family. No, like a real family, not the Olson's, but in any case, they had a lot of money, but she publicly announced that she wasn't going to give any of her money to her children at all because she wanted them to learn how to ... That was Marie Osmond? Yeah, Osmond, right. That's sort of like the Partridge family. Yeah, exactly. And I thought that was really interesting because in the news blurb, there was a comment from another person who was kind of like, well, that's not the right way to do it.
00:18:26
Speaker
But I've certainly heard of very wealthy people who don't give their kids anything and then there's very wealthy people who make life too easy. So that makes me think of self-care. You kind of want to give yourself the right balance as well. Yeah. Between some kind of insistence that you do things a certain way but with room to kind of experiment and self-correct and, you know, fail and come back to the task. Right.
00:18:57
Speaker
Yeah, Marie Osman, sorry. Okay. Oh, so I think this is something that really does come up a lot and it's easier sometimes to look at others and people that we love and just see that they're not caring for themselves in the way that we would want them to. Oh, yeah.
00:19:26
Speaker
Yeah, yeah, that's very painful. It is. It is. And I think part of the sort of balance is trying to figure out when and how to intervene, when to support, and when to really lay off.
00:19:45
Speaker
Well, I think one of the reasons is so distressing is because people who you want to help them and you're not able to and so there's a feeling of powerlessness. And when people feel like that in relation to someone who they care about a lot, it's a very difficult choice to make because depending on your personality, you might be someone who lashes out at that person.
00:20:09
Speaker
Right. It's very common because it seems like they don't want help. And a lot of times if people aren't doing what they seem like they could be doing, the natural response people have is to judge them and blame them for not helping themselves. Or for rejecting help from others. Right. And then the question is kind of like, well, what's going on under the hood? Like, why would someone reject help?
00:20:34
Speaker
What's your answer to that question? I think, well, what we discussed before is that it can be very overwhelming for people who aren't used to others expressing concern or caring that can make someone feel really uncomfortable if they're not used to that level of affection.
00:21:05
Speaker
Are you uncomfortable right now? No, I'm thinking about it because there's an idea that being self-compassionate is helpful for people.
Compassion and Resistance to Help
00:21:19
Speaker
And a lot of people recoil from that idea for different reasons. It can feel new-agey, or if it's too prescriptive, it can feel like it's too
00:21:33
Speaker
because it comes from an Eastern spiritual tradition, but there's also a lot of evidence that cultivating compassion helps the brain in a lot of different ways, meditation in general, which I won't go into the research on that.
00:21:48
Speaker
But one of the interesting things is if you have someone who has difficulty with the idea of being compassionate toward themselves or others or receiving compassion, there's something called the fears of compassion scale, which is a rating instrument developed by psychologists and people can Google it. And it has three sub-scales and one is fear of giving compassion, one is fear of receiving compassion.
00:22:16
Speaker
And one is fear of self-compassion if I'm remembering properly. So I think of help rejection as kind of fear of getting kindness from others. And a lot of times it does seem to go back to some unresolved
00:22:30
Speaker
childhood trauma or adult trauma and it doesn't have to be like a one-time thing, kind of a chronic not being loved or being mistreated where you don't have a good feeling about yourself or you don't have a secure sense of self and then it's like kind of why do I deserve it. But that scale is interesting because it breaks it down into 13 different specific aspects that I don't think we're going to go into all of them.
00:23:00
Speaker
Were there any that stuck out at you? I'm sure there were. I'm sure there were. One thing is people feel weak if you want others to be kind to you. Another is a fear that people won't be understanding when you need them to be. That's a terrible disappointment if you actually take the risk of opening up and the person isn't there for you.
00:23:26
Speaker
And then you kind of learn not to do this. Others are afraid of getting dependent on care from others because they won't maybe always be there for them. People doubt the sincerity of others kindness and people can sometimes even feel frightened or ashamed when people are kind. Those are a couple of the ones that really resonate.
00:23:45
Speaker
Is there anything about feeling like they owe the other person, like how would that kind of thing work in a romantic relationship or any kind of, you know, where one person is sick or suffering or and really can't take care of themselves and then the other person has to step up?
00:24:08
Speaker
What do you think? What do you think is important there? No, I just wonder how it affects the dynamics of the relationship and I can imagine that that can be a very scary thing and that it can...
00:24:25
Speaker
Someone who is a pillar of strength in their family for decades suddenly gets sick. Is that person less likely to be able to accept care from others than someone who has been kind of needy all along, or there's been some sort of an equal balance of caregiving and caretaking? I don't know.
00:24:49
Speaker
Well, I think that makes sense. If the person's identity is organized around always being strong in a certain way, then that's pretty common, right? When people need help, they become really irascible and difficult. It's a hard pivot for people to make when they've always been, as you said, the pillar of strength. And it's not always the case that there's kind of a healthy give and take. And if there hasn't really been a healthy give and take,
00:25:16
Speaker
If it's either been lopsided or transactional, then when bad stuff happens, the system isn't really resilient.
Family Resilience in Crisis
00:25:28
Speaker
makes me think about the response to coronavirus in a way as well because we're seeing which systems are resilient. There's a lot of discussion about which countries responded well and are we taking care of ourselves properly or not? It can be very much like bringing people together but at the same time, of course, it can be very divisive.
00:25:52
Speaker
And I think something like that happens in families too when someone gets sick. It sort of brings out the best and the worst.
00:26:00
Speaker
Right. And do you think that there's anything that people can do to, because this is something I think that comes up with aging parents pretty frequently, that balance between wanting to step in and take care, but also wanting to respect someone's autonomy? What do you mean?
00:26:27
Speaker
Meaning, let's say there's a parent who is clearly not able to, I don't know, dress herself or cook or, you know, just safely manage a household, but she's been a total balabusta for the past 50 years. What can people do? Do you know what a balabusta is?
00:26:52
Speaker
I do, but I'm not sure if everyone does. Okay. So it's like a Yiddish word for a really good hostess and like a Martha Stewart. Let's say she's been a Martha Stewart for decades and then all of a sudden she needs help around the house, which is totally inconsistent with everything she's ever been and known.
00:27:17
Speaker
I think you'd probably be better equipped to help her than I would. How would you approach her? No, I'm just saying that I think that people have to be discreet when offering care. Like sort of tactful. Yeah. Strategic. Right, tactful, strategic to- Test the waters. Test the waters. Test the waters. To really understand what's a safety issue and what's not.
Caring for Aging Parents
00:27:48
Speaker
show good judgment and discernment. When you say what's a safety issue like stuff that you really have to make sure is taken care of and other stuff you can kind of let slide a little. Yeah, like maybe that person shouldn't be cooking, right? Because that's a potentially
00:28:05
Speaker
dangerous thing. And that's the hardest thing because that's been like her thing, maybe her creplach and her matzah balls. So what would you do? Would you try to help her teach her grandson how to do it so that there's a way to kind of parlay that into not a total negation or redirect it? Yeah, or to allow people
00:28:30
Speaker
to step in for some of the heavy lifting but still let that person oversee things. I don't really know. But I guess. Sort of find a way to kind of make her really feel comfortable choosing to take over directing people and then her pride is preserved and she hasn't felt embarrassed in any way because you've been very artful about it.
00:28:59
Speaker
And she maybe understands on some unspoken level what you're doing but you're kind of going along with it quietly, tacitly. And so she accepts the role of kind of directing the kitchen and then everyone gives her the honor that's due to her and she doesn't have to kind of admit to feeling vulnerable.
00:29:19
Speaker
And that would be a good outcome. Yeah. And so that's, I guess, sort of my fantasy of if we have the right strategy and if we think things through and operate from a place of intention and kindness, then maybe we get an outcome that's more like that and lets wrestling a dozen eggs and lots of meal away from an old lady. You don't want to fight with a balabusta quickly becomes
00:29:45
Speaker
Someone else, right? Tough,
Concluding Thoughts on Self-care
00:29:48
Speaker
tough. Well, my fantasy is that that's kind of what you have to do with yourself sometimes, you know, because a lot of times people have trouble making themselves take good care of themselves because psychoanalytically we say it brings out resistance, you know, there's some opposition to it.
00:30:03
Speaker
So, you have to kind of judo yourself into it and I think one way to do that is with gratitude and compassion and acceptance and forgiveness if you can tolerate being nice to yourself. Yeah, absolutely. I agree. Any final thoughts here? I don't know.
00:30:27
Speaker
So I think if we want to wrap up this discussion, which we probably can, to really think about the ways in which we want to take care of ourselves, the ways in which we want to take care of others, what is our capacity for it, and how to know, just kind of keep checking in with ourselves about kind of a bandwidth we have for that.
00:30:55
Speaker
Well, that leaves an open question, which is, how do you stop playing hide and seek with yourself? And how can you be honest with yourself without being too honest? Right. I agree. So I think anything else you want to say? Or can we? Well, take good care and. How do I close my emails?
00:31:23
Speaker
Yes, take good care, kind regards. Yeah, and thank you for listening to Doorknob Comments. Yeah, and have fun. Thank you for listening to Doorknob Comments. This podcast is for general informational purposes only and does not constitute the practice of psychiatry or any type of medicine. It's not a substitute for professional and individualized treatment services and no doctor-patient relationship is formed. If you feel that you may be in crisis, please don't delay in securing mental health treatment.