Spiritual Practices for the Dark Night -- Giving Thanks

I don't believe in New Year's resolutions. They tend to be such cliches. Quit smoking. Exercise. Lose weight. Well, if you are serious about losing weight, you gather information, you set goals, you plot a course, you prepare your house, you find a buddy (just like in AA), you plan each day, you think a lot and you practice. It's worth doing, and I did. The point of all of the above is to change the way you eat. Permanently. So I did all of the above and I feel great (at least about the way I eat). I wish you all the success in the world.

Christians get a second shot at the diet thing in Lent, which begins sometime in the middle of February. It doesn't fare any better than New Year's diets, because so few people want to change their life. They want a quick fix for that swimming suit or class reunion. That's why Lent. It's time limited, forty days, with Sundays not counting. Sundays are free days, for all the bad habits you resume once Lent is over.

Me, I am interested in changing my life. You may be, too, if you too have peered into the dark abyss and something still holds you back from the edge. We are tired of living on that edge. It's just too scary. It wears us out.

So I take advantage of whatever reflecting you might be doing on your life this time of year to introduce some spiritual practices that could change it.

Now don't get twitchy because I use the word "spiritual." Yes, I am a priest; and yes, I have a charge on my life; and yes, I do my best to follow Jesus. It causes me pain that many of you do not have access to that most powerful juju, because of how badly Jesus is represented by some people who have such strange ideas about how to follow him. And I ask him and you also to forgive me for how little I ever do about that.

But give me a hearing. I even changed the title for you. I could have called it "spiritual disciplines," which is how I think of them, and which connects these practices to their deep roots in my own and other religious traditions that have been around a lot longer than you or I, so that you might give them a chance to find out why they have stuck around so long.

Anyway, "practices" gives the sense that if you mess up one day, well, that's what people who are practicing do. Then they practice some more.

Having spent so much space on the title, I can't get to all three practices today. For which I am glad, because I do better when I don't have to figure out what I will write about, and now I know for three weeks, because I have just created another series. I hope I will remember the second practice, which I don't right this minute.

I try, I don't always succeed, but I try to start each day with three things for which I am thankful. I am not particularly profound, nor even moved.  I just notice three things. Today I am thankful that the sun came up. It didn't come out, but I can cut it slack some mornings. I haven't been out yet either. But it came up. That's a start, for which I am thankful.

I am thankful that I have a psychiatrist who listens to me. Let's not spend any time on the one who didn't. Let's focus on the present, for which I am thankful, because she listens to me.

I am thankful that my sweet Mazie is still alive. She has renal failure, and every day we notice more signs. It began with weight loss, then bad breath. Now she needs to go out several times a day, instead of three. I am the one who takes her for two long walks, and that gets me out, as well as up, whether the sun is joining us or not. Which is good for my mental health and for my heart, and so I am thankful.

Three things for which to give thanks makes me mindful, makes me pay attention to the present, which is a gift, which is why it is called the "present." For those of us who have peered into the dark abyss, the present is indeed a gift. Because we can imagine not receiving it.

Sometimes I forget to practice this practice. But I almost always give thanks at mealtime. That covers me three times a day. I give thanks for the food, for the hands that prepared it, and sometimes for those who grew it and picked it, and those who packed and delivered it. When appropriate to the menu, I might thank the chicken or the pig, and while I am at it, I apologize to them that I am not yet a vegetarian.

When I am in Central America, I hear my friends giving their thanks in quiet and rapid Spanish, so rapid that I can barely pick out a few words. But I hear them pray for those who do not have food, and for a world in which everyone will have food every day, like we pray in the Lord's Prayer: Thy will be done. Another word for this kind of prayer is mindfulness.

I was at a restaurant once on "A Day Without Mexicans," when lots of people from Central America stayed home from work to demonstrate how much the rest of us depend on them. I overheard a woman ranting at this demonstration, and how "they should go back to where they came from." All the while, she was eating a big beautiful salad.

Since that day, sometimes I pray, "Bless this food and the hands that prepared it. May it bless us or curse us, according to how we treat those who brought it to us." That is mindfulness, too.

I treat this practice gently. Once in a while I wonder who I am thanking, and that reminds me how mad I still am at God about this disease. I don't know how to give thanks for that yet. Part of my dark night is this alienation from God. Even alienation is a relationship. But it's not one I want to press too hard.

Don't press it too hard.  Thankfulness will do its work over time.  Treat it as an experiment, to find out what it will work in you.

Happy New Year.

OMGThat'sWhatTheySaid! -- Stigma

On November 26th, the New York Times published an article about the presidential policy not to write letters of condolence to the families of service men and women who commit suicide in a war zone.  These letters of condolence have gone out since Abraham Lincoln started writing them during the Civil War.  Given the upswing of suicides in the Armed Services lately and the attendant publicity, this policy of silence, which began in the Clinton era, is coming under scrutiny and challenge.
In response to this article, psychiatrist Dr. Paul Steinberg wrote an Op-Ed commentary titled "Obama's Condolence Problem," winning him this month's OMG Award for -- oh, it's hard to choose.  There are so many prize-worthy lines.  But let's call it for: Indeed, there is nothing wrong with stigmatizing suicide while doing everything possible to de-stigmatize the help soldiers need in dealing with post-traumatic stress and suicidal thoughts. I will deconstruct this sentence after putting it in context.

Dr. Steinberg is concerned that any recognition of suicide, even the reporting of it, glorifies it and makes the taking of one’s life a more viable option. If suicide appears to be a more reasonable way of handling life’s stresses than seeking help, then suicide rates increase.

Dr. Steinberg is clearly in the voluntarist camp, believing that people make a conscious, reasoned choice to kill themselves.  Suicide, in his view, is an option, a way of handling life's stresses.  He is in, if not good, then plentiful company, who believe that even while the thought processes of those who commit suicide are impaired, their will is not. They remain responsible for their choice.

Regular Prozac Monologues readers know that I am not in the same company.  Dr. David L. Conroy gave me the words.  From Out of the Nightmare: Recovery from Depression and Suicidal Pain, "Suicide is not chosen; it happens when pain exceeds resources for coping with pain."

Conroy describes the many ways that people who are suicidal attempt to reduce their pain and save their own lives.  Those who are suicidal sometimes use the language of choice and reason.  Conroy, who speaks from personal experience, says it is terrifying to have such little control over our own emotional state that it can shove us headlong over the abyss.  This lack of control is part of, and adds to suicidal pain.  To claim that we have considered the options and are making a reasoned decision is a grasping for the image of control; it is an effort to relieve pain.

Steinberg asserts that choosing suicide over treatment is deserving of shame.  Now that first-rate treatments for depression and post-traumatic stress have evolved and are readily available, and people with emotional problems do not have to suffer quietly, are we taking away the shame of suicide?  When he decribes depression treatments as first-rate, he parts company with the National Institute of Mental Health and many doing research in the field, who acknowledge the true state of treatment.  At least a third of those who seek treatment are not able to find a medication that is effective and tolerable.  Meanwhile, certain side effects of these first-rate treatments themselves increase the risk of suicide, doubling it in the case of insomnia, a frequent side effect of SSRI's and SNRI's.  Akathesia (called "inner restlessness" on prescribing information sheets) is one of the most under-reported side effects, due to euphemisms, and among the five top risk factors for suicide among hospitalized patients.  [Side note: when you read "inner restlessness" on your prescribing sheet, did you realize that "inner restlessness" could significantly raise your risk of suicide?]

Steinberg believes that letters of condolence to family members could be an inadvertent incentive to suicide.  In light of the condolence-letter controversy, the administration is appropriately reviewing the policy that has been in place for at least 17 years — and may indeed want to consider leaving it as it is. But as a country, let’s focus our energies on doing everything we can to diminish inadvertent incentives that might increase self-inflicted deaths.  And elsewhere: We need to find the right balance between concern for the spouses, children and parents left behind, and any efforts to prevent subsequent suicides in the military.

I feel downright silly answering this argument.  But here it is:

First, the shaming of suicide is indeed one of the resources that we possess against it.  But it is an even more significant reason why people do not acknowledge and seek help for thoughts of doing it.  Shame interferes with willingness to report symptoms.  And failure to report symptoms is a significant factor in failure to recover.  To think that we can shame suicide and prevent it at the same time is fanciful. There is no balance to be found here.

Second, it is well known that surviving family members are themselves at greater risk of suicide.  Shame increases their pain, including their suicidal pain.  It is a barrier that prevents them from seeking support and prevents friends from offering it.  A letter from the President could go some distance in reducing the shame of family members and providing comfort in the midst of their pain.  If prevention of suicide is the goal, here is the most direct intervention the President could make.

Now back to the beginning.  Indeed, there is nothing wrong with stigmatizing suicide while doing everything possible to de-stigmatize the help soldiers need in dealing with post-traumatic stress and suicidal thoughts.  Putting to one side the impossibility of de-stigmatizing the second while stigmatizing the first, let's take a closer look at what Dr. Steinberg wants to de-stigmatize -- the help soldiers need.  What help would that be?  Psychiatry, leading the mental health professionals.

Steinberg wants to stigmatize suicide and de-stigmatize himself.  That's natural enough.  Nobody likes to be the object of stigma.  People who experience suicidal pain can identify with him in his desire. But I took a fanciful direction upon reading this op-ed piece.  I imagined Dr. Steinberg as a chaplain taking a course in Clinical Pastoral Education.  Are my clergy readers following me here?  Think back to your CPE experience.  Imagine the conversation in group after Dr. Steinberg says Indeed, there is nothing wrong with stigmatizing suicide while doing everything possible to de-stigmatize the help soldiers need in dealing with post-traumatic stress and suicidal thoughts.  Somebody from my CPE group would surely have asked, "How does it feel to be the object of stigma?"  And if he returned the question with a quizzical look, "How do you feel to know that people would rather commit suicide than come to you for help?  What does that mean to you personally?"

To my psychiatrist readers (do I have any?), do you have any training like CPE, where you are asked to examine your personal feelings and consider how they affect your judgments and your treatment of patients?  Does it include your judgments about suicide?  How do you feel about yourself when one of your patients commits suicide?   How do you feel about that patient, and the next patient with suicidal ideation?  Can you acknowledge those feelings?  Is shame part of your own experience?  Where have you put your shame?  Your feelings are just that, feelings.  Can you use them to inform your understanding of your patients?

I posted a facebook status last week with a link to Dr. Steinberg's article, asking, "Do patients with any other disease face such disrespect from their doctors?"  I am going out on a limb here.  But I wonder if many psychiatrists have not yet dealt with their feelings about their patients' dying.  When oncologists did, the treatment of cancer patients changed.  Now, who even remembers that cancer once was shamed?

In the bleak mid-winter frosty wind made moan,
Earth stood hard as iron, water like a stone;
Snow had fallen, snow on snow, snow on snow,
In the bleak mid-winter long ago.

Our God, Heaven cannot hold Him nor earth sustain;
Heaven and earth shall flee away when He comes to reign:
In the bleak mid-winter a stable-place sufficed
The Lord God Almighty
Jesus Christ.

Angels and archangels may have gathered there,
Cherubim and seraphim thronged the air,
But His mother
only in her maiden bliss
Worshipped the Beloved with a kiss.

What can I give Him, poor as I am?
If I were a shepherd, I would bring a lamb,
If I were a Wise Man, I would do my part, –
Yet what I can I give Him, give my heart.

poem by Christina Rossetti. 1872
painting by Ivan Shishkin, 1890 

Prozac Monologues at the Movies

Oh, boy!  Butter up the popcorn, slip in a dvd, relax.  This is one very safe and friendly way to spend time with people during the holiday season, and my final installment of this year's Prozac Monologues holiday survival series.  I want my doc and everybody else to notice the implication, that I will survive to do another series next year.

Well chosen movies can fill time, avoid awkward conversation, provide common ground and keep you in the present, always a good thing for the mentally interesting.  Here are my selection criteria for holiday diversion movie viewing:

Movies For Fun

Tips for Surviving the Holidays: the Prozac Monologues Version

Ah, the holidays!  Time when far flung family members travel home and grow close around the Christmas tree.  Time to renew friendships in a round of parties and frivolity.  Time to go crazy?

There are stresses this time of year.  Routines are disrupted. People stay in crowded quarters. Those who have reason to avoid each other are thrown together. Negotiations between exes require professional mediation. Alcohol is consumed in greater quantities. Expectations for love and good cheer are bound for disappointment. Loonies and normies alike need to tend to their mental health.

So Prozac Monologues continues your handy holiday guide, with an assist from NAMI's Peer to Peer class and the University of Iowa Adult Behavioral Health department, covering the basics, planning ahead, mindfulness and quick getaways. 

The Basics:

Keep to your routine as much as possible. If you can't eat like you do at home, get at least one nutritious meal every day. If your family of origin was a little whacked, and your root chakra could use some assist, concentrate on protein (meat, fish, tofu, beans), root vegetables (carrots, beets, onions) and red stuff (beets, strawberries, cranberries, cherries -- jello does not count.) Don't go to parties without some protein already on board. At the buffet table, carrots. Skip the dip, limit your lipids. You will sleep better for it.

Remember Lloyd Bridges in Airplane? The holidays are not a good time to stop sipping, smoking, snorting, sniffing... You get the idea. On the other hand, ultimately substance abuse is more a hazard than a help in negotiating tricky family dynamics. So keep it under control.

Sleep -- not so easy if you get the couch in the family room. Borrow somebody's bed for a nap. If you anticipate a problem, I'm all for an occasional pharmaceutical assist, as an alternative to the straight jacket, which is where you may be headed if you don't get good sleep. This is true for everybody, essential for people with bipolar.

Safety -- no, you do not have to hang around anybody who is abusive. If that is an issue, have your escape plan ready, your keys and your credit card in your pocket, your alternative crash pad arranged.

Oh, and water -- with all your meds, you are probably supposed to push water, as it is. Even more so in the dry winter air. Even more so when dehydration can be mistaken for hunger, leading to more cookie consumption, requiring more water. Especially even more so with greater alcohol consumption. Be kind to your liver. Drink water. 

Planning Ahead:

Many a family feud could be short circuited with some conversation ahead of the storm. Which chores does the host want or expect help with? Which chores does the guest want to volunteer to do? In any relationship, 50/50 does not work. You have to give at least 60%.

Is there any tradition, activity, food, game that will blow your anterior cingulate cortex if it doesn't happen? Take some responsibility for it. Laugh about it, and let people know. And if it doesn't happen, well, that will give you material for your next therapy appointment. And you already know what your therapist will say, don't you.

How many events are planned? Which ones can you skip? Is there room for negotiation? What would you like to do in a group? When will you want to go off by yourself? When will the one who abused you as a child be around? Where will you be instead? 

What are your needs? What are others' needs? Talk to each other. Listen to each other. Remember, there is no Hallmark Family Christmas, except in Hallmark commercials. These are ads, people. They are not your family, and they are not mine, and they are not anybody else's, either. Give yourself and your family a break. Your relatives, your tree, your cookies and cocoa are infinitely more entertaining, anyway. 


I am here, this is now. That's my chant, accompanied by some deep breathing, calling me out of the unhappy past and the uncertain future. Look up, listen up, and notice. You don't have to participate. Just notice. Concentrate on the senses, smells, touch, hearing, sight, taste.

When things get especially bleak for me, I go outside, regardless of weather, and try to replace the running voices in my head with a minute description of what I see around me. There is a little girl. She has pink leggings on. Her hair is in ponytails on either side of her  head. The woman is pushing the stroller. The tree is a pin oak and still has its leaves. The passing car is a Volvo. We used to have a Volvo. It always... -- no, that's the past. This Volvo is dark green... You get the idea.

When you can't get outside, like during Christmas dinner, become an anthropologist. Like Margaret Mead. Who are these people? What do they think? How do they treat each other? What are their eating habits? What happens after three beers? You are not responsible for any of it. You do not have to stop what you don't like. You don't even have to like or not like. You are simply an observer.

Mindfulness is a practice. Practice is what people do when they want to get better at something. Remember, if you can't pull off mindfulness every time you need it, that's okay. You just need more practice. 

Quick getaways: 

There is one more thing you need, some handy lines to get you out of the inevitable spot. Let's see how many of these you can anticipate.

There you are, being Margaret Mead, mindfulnessing away. And Uncle You Know Who turns to you and says... What will it be this year? Immigrants? Climate change? What he thinks about all this therapy you're doing? He knows your triggers like the back of his hand, because he trips them every year. Well, write this one down on the back of your hand, That's very interesting. I'll have to think about that. That one can get you out of all kinds of arguments. Sometimes it even gets my therapist off my back.

Or there you are, seated next to the cousin you haven't seen since she tried to drown you in the pool when you were kids. Remember, you are here, this is now. Try, Seen any good movies lately? It matters not a whit if that line is a dud, because it sets up your next line, What do you do with your time nowadays?

Then there is the open-ended How about them Hawks? Or Vikings, or whatever. Do a little research ahead of time, so you know a team near the person you are addressing. For the sport challenged, here is a starting point: it's football season. And if that line is a dud, follow with... are you with me yet?  What do you do with your time nowadays?

When you must escape the person or the room, there's: 
  • Excuse me, my drink needs more ice
  • I'm going out for a smoke/some air/to make snow angels
  • and, Do you know where the bathroom is?
And when you have had your limit: I really must go. Thank you so much for the party. Merry Christmas. With a normal host, I mean really normal, not undiagnosed normal, you don't need to explain anything.

If the host is in the undiagnosed category, try: 
  • My puppy/probation officer/Nurse Ratchet is waiting up for me.
  • Or: I'm sorry, suddenly I'm feeling flu-ish. You can play the flu for all it's worth this year. 
  • Or even, Oops, my meds are wearing off. Gotta go!
  • If somebody else in the room should be on meds, a simple I'm outa here will suffice.
Make yourself a crib sheet, and these few lines will help you navigate a wide range of social situations. Do you have anything else you want to recommend to fellow readers? Make a comment!

There is one more strategy, diversion. I will cover diversion, in the form of recommended movies for the holiday season next week.  Put your recommendations (and reasons) in the comments this week.  I am happy for all the help I can get!

Families -- you gotta love 'em. And you can always laugh. It really works better if you do. Happy Holidays!

clipart from Microsoft online
photo credit Edward Lynch
popcorn credt Francesco Marino

Unintended Consequences.

A few posts ago, John McManamy and I began a conversation about brain surgery to treat mental illness.  You can follow that thread at his blog.  The link will take you to November.  The comments under Me, Captain Ahab and the Anterior Cingulate Cortex are that conversation.  

It seems that brain surgery for mental illness is the topic of the season.  Yesterday the New York Times published the story of Henry Molaison, who had surgery in 1953 to remove part of the medial temporal lobe, including most of his hippocampus.  1953 was four years after António Egas Moniz received the Nobel Prize for his lobotomy procedure, targeting the frontal lobes, and fourteen years after Moniz retired, when he was paralyzed by a former patient who shot him in the back.

The intented result of the surgery in 1953 was to relieve Mr. Molaison's seizures, which he had since childhood and were getting worse, so much so that at the age of 26, he consented to this experimental surgery.  And the surgery was in fact successful.  It relieved his seizures.

Now everybody who has ever quit a medication because of side effects, or had ECT, or did a good deed that went horribly wrong knows about unintended consequences. It soon became apparent that Mr. Molaison's short term memory was gone.  If you have seen the movie Fifty First Dates, it wasn't gone like Drew Barrymore's, who forgot every night what happened that day.  It was gone like the man in the hospital, who introduced himself to people he was having a conversation with, over and over and over.

In the letter to the Romans, chapter 8, Paul says that God makes something good come out of anything.  He doesn't say that the new good measures up to the previous bad.  But it's something.  In this case, one person's tragedy was science's incredible research opportunity.  From all the experiments subsequently conducted on Mr. Molaison, scientists learned a lot about how memories are constructed.  They learned first that the particular part of his brain that was removed is critical for the formation of memories.  Protect your brain!  They learned that there are different kinds of memory.  Mr. Molaison could no longer acquire new information, like where he put his keys.  But he still had his motor or implicit memory; he could still ride a bike.

Mr. Molaison donated his brain to science.  I am curious about the legal implications of consent for a person who has no short term memory.  How long would it take for the docs to describe their desire for the donation and for him to absorb the information and make a decision, one which presumably he would not remember the next day?  Is it informed consent if the next day, (not to mention 52 years later, before he lost his life to pulmonary complications), he would not remember his consent to be able to withdraw it?  Would the law school readers and human research subject reviewers weigh in here?  Let me add that with his memory intact but his seizures undiminished, Mr. Molaison might not have survived to the age of 82.

Anyway, continuing the one enormously good, though unintended consequence, right this very minute they are busy shaving off pieces of his frozen brain in coronal slices, and photographing each slice, to give the most detailed pictures in existence of the structures of the brain.  These slices are measured in microns.  They will get 2500 of them out of this most famous brain.

My spouse, who works for Nancy Andreasson, the researcher in schizophrenia, (Broken Brain) says that the brain images they have from MRI's measure a millimeter.  They get 196 slices (that's what they call them, but they are pictures, really) out of the coronal view.  The side view is pictured here.  Imagine slicing it like a loaf of bread.  Your face is the left end of the loaf.  When you put the slice flat on a plate, you are looking at the coronal view.

And actually, as I write, they began a break at 8:40 AM, California time, while they change the blade.  They have already passed the damaged part of Mr. Molaison's brain, and expect to finish sometime this evening.  These images will be studied for years, maybe decades.

Obviously, nobody is doing the procedure used on Mr. Molaison anymore.  I believe that they do experiment with a pacemaker-like device that gives a periodic electrical charge to the brains of people with epilepsy.  A similar technique is one of the experimental procedures used on the anterior cingulate cortexes of people with OCD, obsessive compulsive disorder, and people with depression.  The advantage of the pacemaker device, called deep brain stimulation (DBS) is that presumably it is reversible and can be removed if the unintended consequences are not so good.  The other psychosurgeries that involve actual cutting or burning are not reversible.

These experiments are conducted only on the people who are most desperate for relief.  Sometimes they get relief.  Often they get something else, as well.  When weighing the pros and cons, I suppose that one of the pros is , however it turns out, they will advance what we know about the brain.

Photo from MIT 
Permission is granted to copy image under the terms 

News Flash -- Unintended Consequences

If it's still Friday and if you pay attention to science or technology or the brain, or if you think that live feeds are cool, then zip on over to the lab at UC San Diego RIGHT NOW where scientists are peeling 2500 slices off of a man who was brain damaged 57 years ago, during an experimental surgery to relieve his seizures.  Ever after, his short term memory was good for 15 minutes at a time.  He donated his brain to science, and this is what they are doing with it, to study memory.

I have to get cookie dough made, and will fill out this story later.  But they might finish the live feed today.  So watch it now, and read the story later.

Holiday Shopping for Your Favorite Normal

A friend once described what it was like to have cancer.  Like having a paper bag over your head, you can't see anything outside the bag.  It's all about you and your cancer.

Mental illness can be like that.  Try it for yourself.  Put a bag over your head.  Make sure it's not plastic!  Our issues can be all consuming, our fears, our doubts, our grief, our hysteria, our voices...  We lose track of the world outside our paper bag.

But outside that bag are friends, family, allies.  There are more of them, and they are truer to us than we can imagine when inside that paper bag.  The bag, our absorption in our own concerns, makes certain life skills difficult.

Like holiday shopping.

To do a good job at holiday shopping, you have to pay attention to something, or someone outside your own inner world.  So before I give suggestions to loonies about what normals like for Hanukkah, Christmas, Kwanzaa, here are first steps.

The first step to successful holiday shopping is to turn your attention away from yourself.  Remove that bag from your head.

The second step is to focus on the person for whom you want to shop.

The third step is to pay attention.  Engage your eyes and your ears.  Watch and listen for clues.  If you want to please this person, you need to find out what would please this person.  Write it down, if you have memory problems.  I assume that you have memory problems.

I have a hard time paying attention to the world outside myself.  I pay so much attention to my world inside that I trip over cracks in the sidewalk, bump into furniture, nick myself with a knife (but not on purpose!)  I bruise myself and don't even notice until my wife sees it and asks me what happened.  I have no idea.

When I decided to write this post, I realized I would have to follow my own advice.  I had to pay attention.  Actually, given the time constraint, I took the direct approach.  I asked Helen, "What would be a good gift to give a family member of somebody with a mental illness?"

She said, "A cure."

Such is the love available to me every day outside my bag.  Five years after Prozac, I can cry again, and I almost did.  I wrote "a cure" on my list.  Then we went on.

Of course, I got a list of things that Helen would like.  That is the point.  The people who love you are just as unique as you are, you little snowflake.  We got a catalog from Target today filled with gift suggestions.  Some of them may work for the person who loves you.  Some of them won't.  You can't trust the catalog for good guidance.  That is why I gave you the technique for figuring it out.  Talk to them about what's in the catalog.

Having observed your loved ones, so that you know their interests, having paid attention so that you might even have heard, "Gee, I wish I had...," or seen them pick up something at a store, then you are ready to go out shopping.

No, those of us with PTSD or OCD or whose meds wear us out or who feel like whale shit at the bottom of the ocean do not want to go out shopping.  The internet is our best friend, at least for the length of time it takes us to do our shopping.  Internet shopping does require a credit card, so those with bipolar might need supervision.

Simply google the source of your desired gift, Williams Sonoma for all things cooking, Eddie Bauer, Old Navy, Victoria's Secret, etc. for clothing, Cabela's or Scheel's for all things sporty, Amana for meat, See's or Godiva for chocolate.  See's makes the gold foil chocolate coins for Hanukkah's dreidel game.  Chocolate is also a fabulous Christmas gift, or for any occasion whatsoever.  [Does anyone know a tie-in to Islam?]  And it stimulates the production of dopamine.  So you might want to order some for yourself, while you are at it. Oh, and Amazon for just about anything.

If all the choices are just too much, get a gift certificate.

If your meds or your disease has destroyed your credit, so this is a cash deal, and if you can bear the public appearance, you can now buy at the grocery store gift certificates for all kinds of other stores, restaurants and websites.  Purchase your chocolate and do all the rest of your shopping in one stop.

If you are having a good day, head out to the mall for baskets of bath salts and candles, next year's calendar, movie coupons, cheesy popcorn, that toy workbench that I recommended your normals buy for you, and a truly amazing assortment of gadgets that you never knew anybody needed and that nobody will use by December 27, but it is the thought that counts. That "thought that counts" thing only works for your mother, by the way, and not really for her, either. Play with the worthless gadgets in the store.  Then give them a pass.

Weekdays, mid morning are safest for the mall.  I wouldn't dream of going there unless pharmaceutically protected.  Bring a friend who can drive after you collapse.

But if the cost of meds or the consequences of your disease (you know who you are) has destroyed your credit, you might like a more personal (read:cheaper) approach.  Write a poem or a story.  Draw a picture.  Make a collage.  Frame a photo.  Knit a scarf.  Bake some cookies.  Remember that thing about chocolate and dopamine.  Fudge!

I don't believe in those homemade coupon books filled with promises you can't keep, like how you will do your own laundry or cook dinner once a week, walk the dog, smile once in a while.  Don't promise.  Just do something that your normal has been begging you to do: make that doctor's appointment, attend that group, remove the leftover pizza from your bedroom, wash your hair...

Write a letter of appreciation.  That one works especially well with your mom.

clip art from Microsoft.com

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