ten things to know if you're taking an anti-depressant

1) It’s important to know what you’re taking the medication for. This might seem like an obvious point, but I see patients all the time who are taking anti-depressants and don’t know why they’re taking them. What are you targeting with the medication? Anti-depressants can be described for different things: depression, anxiety, pain management, obsessiveness, vertigo. It’s a good first step to narrow it down to one of these categories, but it’s possible to be even more precise. Depression, for example presents with different symptoms in different people. For one person, depression may present with irritability, feelings of sadness and loss of interest in usually pleasurable activities. In another person, depression may present as loss of appetite and sleepiness. If you don’t know why you’re taking the medication, it will be impossible to know if the medication is doing what it was intended to do.

picking up the pieces

ONE OF MY PATIENTS is a young man, twenty years old, who sustained a brain injury last year after shooting himself in the head. He can’t remember how it happened, which is commonly the case with injuries of this magnitude. There’s often a chunk of memory from the days or hours leading up to the injury that’s lost, as well as a period of time after the injury during which the person cannot remember any details. Sometimes the amnesia goes back for months, often erasing major events such as getting married, the loss of a family member or having children. In this case, he can't recall what led him to shoot himself, so it has remained somewhat of a mystery.

levitation

I’VE BEEN GOING in to work this week a couple hours early so that I can finally finish the mural I’ve been working on for like a year. I still have about 15 hours of painting left before the Peaceful Habits classroom is complete, and now that the book has been put to bed for a while, I thought I’d try to finish it up.

what the sign says

NOW THAT WE LIVE in a different neighborhood, I have a new commute into the city. It’s a cool ride. I bike from our apartment near Memorial Park, all along Buffalo Bayou, into downtown Houston — and I never have to stop at a stop sign or a traffic light. The bike trails go over and under the surface streets.

brainglow

BRAINGLOW is the visual adornment of a cartoon brain — usually represented as a disembodied organ — with an outward-radiating illumination-of-sorts. Brainglow doesn’t exist in nature, of course. Brains don’t literally glow blue-green. But you’d never know it from the pictures of brains you’re likely to encounter walking through a bookstore or surfing the internet these days. You see brainglow everywhere — dust jackets, glossy conference brochures, websites promising heightened brain power.

hara hachi bun

THERE’S A CONFUCIAN teaching that instructs people to eat until they are 80% full. As the saying goes, “eight parts of a full stomach sustain the man; the other two sustain the doctor.” I can’t remember who told me about this tradition, but it has stuck with me ever since, and I see echoes of this wisdom in various aspects of life that have nothing to do with eating. A broader interpretation of the teaching might be: “You don’t always have to fill something to its capacity.”

small gold box

I FOUND HIM near the nurse’s station in his wheelchair, receiving a cup of pills in his hands. His right leg, badly mangled in the accident, had been screwed and pinned back together and wrapped up in a soft cast. He couldn’t bend it at the knee, so when I wheeled him around and down the hallway to his room in the locked unit, I was mindful of the large sweep his outstretched right leg made as we rounded the corners.

tea and toothpicks

I’M SO PROUD of my tea assistant, Mr. Blank. He’s been a patient of mine for almost three years, arriving at our rehabilitation center in the summer of 2012. He stayed with us for four months before returning to his home state on the east coast, but ended up in jail soon after his discharge for assaulting his ex-wife. Knowing his history, and with sincere interest in his welfare, the authorities agreed to transfer him back to our center where he could receive appropriate treatment for his aggression. He was very fortunate. I’ve no doubt there are many men like him, with similar histories, imprisoned for similar offenses all over this country. In his first twenty-five years of life he’s endured more than most of us ever will — all manner of abuse, traumatic brain injury, incarceration — so ending up where he did after being arrested was a rare stroke of good fortune for him. He’s been my tea assistant for seven months.

i love electric light

I WAS PUMPING gas early one morning three Februarys ago when he stepped out from under the streetlight. “Hey man,” he said. “Can you help me out with something to eat?” Good sense would have dictated I do the exact opposite of what I did, but it was cold and I felt bad for him, so I pulled out my wallet and opened it.

springwatch

THESE LAST FEW DAYS have tasted like spring. Branches are budding. Birds are busy building nests. Yesterday was baby blue and one thin layer was enough to keep me warm, so I decided to serve an orange blossom green tea to my Peaceful Habits group, to call attention to and amplify that feeling of spring we were all tasting. I served a jasmine green as well. This year I’ve started using two small teapots instead of one large one, a small ceramic one and a small cast iron one. I received the teapots as gifts for Christmas, and I’m glad I did. Now I can serve two teas simultaneously. Now the group is more like a tea tasting.

skull replacement

MR. JONES was the first person to show up for my tea group yesterday. “Good morning,” I said. “Any word yet on when you’re getting your skull put back in?” “Doc,” he said, “I have an appointment tomorrow. I’m hoping he’ll set a date.” And with that brief exchange I could gauge how much progress he’d made since the last time I saw him, the Thursday before Christmas.

pointer finger

YOU HEAR A LOT about mindfulness these days. You hear less about awareness, the sister of mindfulness. They’re two sides of the same coin really. Just as the mind can be sharpened into focus — this is mindfulness — the mind can also be fuzzed out and panoramic — this is awareness. Zoom in to a pinpoint — mindfulness. Zoom out to take in the open space all around you — awareness.

gratitude

THE PATIENTS I TREAT rarely thank me. It’s not that they’re ungrateful. Many can’t speak or don’t know where they are, much less what’s happened to them. And those who can speak and aren’t confused think that nothing is wrong with them and that I’m some kind of jailer. Last week I got punched in the mouth when a life care patient of mine asked me when he would get to go home and didn’t get the answer he wanted to hear. A few weeks ago I got peed on helping a guy having a seizure. Yesterday I got called a f*cker at the end of my first appointment. All in a day’s work.

if you could plant anything

IF YOU COULD PLANT anything, what would you plant? The hypnotist had guided our small group through an enticing gateway, into a sun-lighted corner of an imaginary garden, and was conjuring a fertile patch of freshly tilled earth.

grateful for resentment

A FEW DAYS AGO a friend told me about the gratitude journal he'd started keeping. I told him he should start keeping a resentment journal as well. He thought I was kidding. I wasn’t.

in case of emergency

USED TO BE you could turn off the screen on the seat back in front of you. You had to press the dimmer button eight times for the screen to go blank, and, yes, it would re-illuminate with the slightest provocation — when your neighbor would rest her hand on the armrest, for example — but at least you could turn it off for a while.

peaceful habits — the classroom

THE REHAB CENTER where I work (Touchstone) just built a new multi-purpose building — gym, therapist offices, counseling suites, conference rooms, etc. At my suggestion they included a meditation/yoga space in their project plans. I was honored to learn that they named the room after my program — Peaceful Habits.

two slogans

TWO SLOGANS stayed stuck in my mind yesterday. The first slogan: “Obsessing about getting what you want and avoiding what you don't want does not result in happiness.” It’s from Pema Chodron’s compassion box, which includes a book and a stack of cards to use as daily mantras. The second slogan, an advertisement for greasy convenience store pizza:

japanese plums

THE JAPANESE PLUMS were so orange, so ripe, but the lowest branches drooping over the gate had already been picked clean. Only a tantalizing cluster at the tip of a high branch — beyond my reach, I imagined, even with a running leap. I tried anyway. I’d just finished a twenty-minute walking meditation, and I was feeling in the zone.

gentleness

A BLIZZARD of thoughts and emotions swirls around each of us, obscuring the true nature of mind, but if we learn to sit tall and let the blizzard happen around us, and if we do this over and over, we come to know the blizzard for the emptiness it is, and we begin to see through the snow clouds in which we've become ensnarled.