I’ve always sought to mix a little art and nature into the mix here; both are good for the soul. Moss and Fog is a great site and I hope you’ll enjoy this time-lapse video as much as I have:
[First off, please please PLEASE believe: I have no political or culture wars sort of angle behind the title. Christmas is a tradition in my family. Please enjoy whatever holidays you celebrate.]
So it seemed like a bad week to offer anything but a holiday post. Such a time! Lots of crowds and stress, traffic, stress, crowds… given all the pain and woe you hear about it’s a wonder we still call it a holiday season.
Am I stressed out? Not really. My oldest and most treasured shopping ritual is to go to the mall and walk around a while, buying nothing, looking at nothing except all the people, and simply enjoying that I’m not in a frenzy. Then I go home, my perspective refreshed. Only then can the shopping commence, on some later day. I highly recommend it!
Plus I had an unusually rough fall this year so I’m taking this year’s holiday season easy, doing the minimum. I’m not giving anything up: oh no, I’m pacing myself comfortably, giving myself the present of peace of mind. Hard to beat!
Trust me, I know all about the pressures people put on each other and themselves.
Still, keep in mind with all the madness this time of year: it’s all optional, not duty. Do what works for you and yours, not what everybody thinks you’re supposed to do or what will impress people. We’ve got all year to run the rat race, right? Why not give ourselves a present: peace. Let me tell you, it’s great stuff! Good for the soul, and WAY better than anything on Amazon or at the mall.
One more thing: I’m not talking about being Scrooge or the Grinch: no angry edge here. I’m just keeping it simple. Nice!
That’s my spin, anyway. Take care and enjoy.
No added paperwork, nurses. None!
I’ve put together a curriculum for nurses called Golden Rule Care (GRC): how to build rapport and cooperation with folks who have mental illnesses. Surprisingly, GRC tools help you work with all people. How? GRC focuses on human qualities all people share, nurses and patients alike.
GRC helps nurses make work easier, more efficient and fun. I’ve been using all the GRC techniques for years now: they work. I get far more done than I used to, AND have more fun, AND more free time to use as I choose. Nice!
Now I’m writing my first GRC book. As I go, as IT grows, I’ll share the basics here at Psych Circus. I want to keep these posts comfortably short, so for today I’ll stick to GRC’s basic structure. All my content is organized into three fundamental groups I call Rules. I’d love to call them Golden Rules but that one has long been taken, right? THE Golden Rule: Do unto others as you would have them do unto you. That classic wisdom inspires and informs all my work… so let’s see how.
Rule One: People are people.
Rule one ignores mental illnesses, focusing instead on psychological characteristics we all share. This approach applies to all humans: nurses, patients, friends, families, strangers, everyone! It applies in most settings as well: work, home, the mall, everywhere. Unless someone is under anesthesia or in a coma, theses tools apply because I focus on universal human nature, not illnesses. You can’t talk to illnesses, and illnesses don’t makes decisions about care. People do! Traditional healthcare training largely ignores this fact to focuses on illness.
Strange as it may sound at first, the more I learn, the more I treat my psychiatric patients like I treat everyone else. What works best at work also helps me get better service at the airport, helps me get along with all people all the time. And if such things matter to you, regulators and managers love to see strength-based care.
Rule Two: Everyone is unique.
No added paperwork, remember?
With Rule One, it’s natural to wonder how I dare ignore the individually-tailored care planning so much in demand in health care. Personally, I find mandated “individualized” paperwork far too clumsy and inefficient. It wastes valuable time and energy to keep up appearances instead of serving patients.
I can’t save you from regulatory mandates, but I can offer Rule Two techniques: efficient, practical ways to tailor care in real time as you provide care. You apply basic but GRC-informed nursing process to quickly figure out what does and doesn’t work. You might document or tell others about your successes, but the process itself involves no paperwork. None! In short, GRC tailoring serves patients and yourself better without busywork.
Rule Three: Know Your Enemy.
Know yourself and know your enemy, and you will gain victory a hundred times out of a hundred – Sun Tzu, The Art of War
Now Master Sun was an ancient Chinese general. He wrote about war 2600 years ago. Why in the world would would I quote him? I promise you, I wage peace, not war!
Mutual mistrust and hostility with patients positively clobbers your productivity and quality of life. I see it all the time. Sadly, I wouldn’t be surprised if you wondered if “your enemy” meant patients. It feels that way sometimes, doesn’t it? Sad but true. If you start feeling this way very often, it might be time for a vacation… and no, that’s not at all what I mean.
Patients and nurses are natural allies – hence nurses’s status as America’s most trusted profession years on end. Yet they too often fall prey to misunderstandings and stereotypes, to everyone’s detriment. We can do better.
So who IS the enemy then? No, not doctors, not management, not even insurance companies. It turns out that Who is the wrong question to ask here. Our enemy here isn’t a Who, it’s a What, specifically the mental illnesses that cause so much suffering and grief. Worse, the stigma they trigger yields even more suffering and grief. These illnesses are among the top killers in America, and suicides account for a majority of gun-related deaths. Bad news enemies: bad!
Even though I treat everyone the same, I don’t ignore illnesses. Individualized care means focusing on a given person’s needs, personality and values. You can hardly ignore such a major factor as mental illness and do people justice. Education and illness-savvy care make a huge difference in building rapport and cooperation. Rule three material highlights what you need to know to put such tools to use.
So that’s it, folks, my Three Rules of GRC. In future posts I’ll go into more detail as my long slog called book-writing continues. Thanks for your time, and take for your patience with a bit of a teaser post. Details will follow.
Silly bonus time: Meet the GRC mascot, Three Hair!
I’m forty pages into writing my very first book, and I’m cheating a little, using the some of the same material for blog posts. Efficient!
Anyway, I’ve been writing about Reciprocity, a topic for another post as it’s dear to my heart. Basically, it refers to the human instinct to repay gifts. So I was reviewing gifts nurses could give patients to help build rapport and cooperation. And I came to how to give a gift to patients with a bad reputation or you don’t like or expect to be difficult and frustrating, which brought me to one of my favorite clinical topics, Borderline Personality Disorder. How can caregivers do better? What gifts can they offer?
At a minimum, caregivers, manage your expectations. First, hide them VERY well. As most of us have limited acting skills, don’t try to fake anything when you have strong negative feelings or expectations for a patient: go for a poker face instead, blank, neutral, professional. It takes practice but it’s far easier and more honest than trying to generate something fake.
How is this a gift? Trust me, when a patient has a bad reputation or a stigma-laden diagnosis like Borderline, they meet person after person who in often not so subtle ways shows their contempt. If you show blank respect, that’s a marked improvement. At my hospital we have a trauma unit loaded with people diagnosed Borderline. I used to work there and work on a unit that accepted patients no longer welcome on the trauma unit. I’ve generally got along with such patients rather well and enjoyed my time with them.
I started out with little more than the poker face thing. Then I took it a step further: for clinical interaction purposes, I pretend Borderline doesn’t even exist, that such patients have a traumatic history and symptoms of trauma, depression, and/or anxiety. It works very well! And there’s actually some scientific basis for such an approach.
First, social psychology research shows that our expectations towards other people have surprising power in that they’re self-fulfilling. If you expect someone to be wonderful, it steers them towards acting wonderful. If you expect hostility, you get it. If you expect stereotypical “borderline” behavior, you get that. Offer stigma, you get self-fulfilled “proof” it was accurate. At the same time, a “borderline’s” negative treater expectations influence you negatively, completing a never-ending cycle, a social dynamic of pain for all involved. You both give, you both react. You both create the results. Stigma is a social thing. I expect such interactions to go well, and it makes a crucial difference. And they DO go well, rather better than most people experience.
Second, psychiatrist George Vaillant makes a strong case in his paper, The Beginning of Wisdom is Never Calling a Patient a Borderline (Journal of Psychotherapy Practice and Research Volume 1 Number 2 Spring 1992 117 – 134.) I refer to it from time to time and teach from it. Dr. Vaillant doesn’t argue that such patients don’t have real symptoms, he simply argues that the diagnostic label does them more harm than good. Some diagnoses, especially those once classified as Axis 2 (DSM V eliminated the Axis system) often reflect treater frustration more than anything else. “Borderline” and especially “borderline traits” are often no more than insults, code for “I don’t like this person” or “she’s a real pain in the butt.” How often have I heard staff members disparagingly say “they’re so borderline,” “they’re Axis 2,” or the like? It’s often an ugly slur in respectable clinical camouflage, the exact opposite of scientific or objective. Such stigmatic labeling is not only hurtful: it’s costly too, as we’ve reviewed. It hurts all involved.
Years ago, having seen a talk by Dr. Valliant, I tried an informal experiment. Without telling anyone, I pretended that all the Personality Disorders don’t exist. Based on their individual symptoms, I pretended patients suffered from depression, anxiety, trauma, etc.: no Axis 2. I tailored all education and counseling accordingly. No negative expectations, no judgment. No flawed characters: just people who suffered.
What do you think happened?
Patients appreciated it, cooperative and enthusiastic. Things went smoother than ever before. Without all the negative expectations and hostile misunderstandings that follow these people like shadows, some of their symptoms disappeared as well. Their symptoms weren’t just about them: they were also about how others interacted with them. They were about stigma. Often enough, when a patient gets in trouble, the primary trigger is another person pushing their buttons. Sadly, that trigger person is often a professional caregiver. To the contrary, my new approach made things far better and I’ve made it a permanent part of my clinical toolbox.
Sad as our current state of affairs can be, still, it’s good news! How? Whenever imperfection exists and gets recognized, it becomes an opportunity for improvement.
We can change our own behavior far more readily than we can convince someone else to change theirs. If we trigger another person’s symptoms somehow, we can learn new ways to interact and exert a positive influence indirectly. I’ve found it works rather well and makes clinical work far easier and more fun. Usually, nurses are tempted to avoid owning their mistakes, to see them as threats. This different approach turns our mistakes into pure gold: places from which we can improve clinical outcomes and lives. Opportunities! Stigma-busting helps all involved.
Here’s a crucial lesson I learned long ago.
In health care, what drives people most, what matters most to patients? They’re people, of course. What determines their responses to their treaters and treatment options? The answers matter deeply if you want to do good and efficient work with people, if you want to succeed, if you want to improve your results and your enjoyment at work.
As is, treaters generally overwhelmingly focus on illnesses and symptoms and tend to frame patient complaints in terms of symptoms. That’s how they’re educated and trained. Patients aren’t irritated, they’re irritable. Patients aren’t unsure if they can trust treaters they just met (very) briefly , they’re guarded or even paranoid. Patients don’t disagree with their treaters, they lack insight and judgment. Patients don’t struggle with difficult decisions given vague data and little time to work with, they’re ambivalent and indecisive. And on and on. So it goes every day in health care. Experiences I as a provider often see as completely normal routinely get framed and documented by others as symptoms, in effect as defective thinking, So it goes. Especially among mental health treaters, the entire industry is geared to blame the patient for everything that bothers treaters, everything that goes wrong, everything that differs from treater expectations and desires. Everything! So it goes.
Yet it has been well documented that patient dissatisfaction even in psychiatric settings generally has far less to do with patient diagnoses than most people imagine. No, peoples’ responses to care have far more to do with universal human needs, the stuff that makes us all human, that ties us all together and makes us all essentially the same. Psychiatric illness or not, these needs remain constant and centrally important, timeless. What factors most reliably lead to violence and restraints? Surprise, surprise: diagnoses are very poor predictors of violence, histrionic news stories to the contrary. Far more reliable predictors include unit temperature control, noise, waiting, (in)consistency of rules, perceived disrespect and so on, the kinds of issues that bother anyone. Regardless of illness. So it goes.
When we learn how to address normal human needs more effectively, regardless of illness people appreciate it and treat us well in turn, or at the very least, better. It helps. It makes a difference, it makes all interactions, all people work better. Not perfect: I offer no fairy tales here. It’s impossible to control others like puppets and it’s wrong to try. I have no interest in manipulating or controlling others, for both ethical and practical reasons. I develop and teach ways to make it better, ways to help patients and treaters get along better. Better is enough for me, because it’s real and it’s achievable, today, now.
Have no fear of perfection: you’ll never reach it.
– Artist Salvador Dali
Perfection sounds wonderful and it never actually happens. To the contrary, Better builds on itself step by step, upward and forward, never perfect, never finished, yet ever better. How far can we take such an upward, forward climb? Who knows? The only way to find out is to try it and experience it yourself. I’m not concerned with that end point: I live here and now, as we all do of course. Sadly, most of us mostly focus on the past and the future where we lack power. You can’t change the past at all, not even a little bit: it’s untouchable. You can change the future but you can’t touch it directly. NOW is where better happens, where EVERYTHING happens in fact, and by making things better, step by step, we can build a progressively better future as we go. That’s how better works!
So for the last twenty years I’ve explored and tested and refined ways to help patients and treaters get along better, work better together, get more done and have more fun together. It has made me a far happier and far more successful efficient clinician and patient.
That’s right, I play both sides of the clinical fence. Surprised? There are perhaps millions of us, the mental health fence straddlers. Mostly we hide in plain sight. Not me, though. I use transparency to fight stigma to help save lives.
But that’s for another time. Thanks for your attention, and I appreciate any feedback you might offer. I live to learn from others.
My old blog, BigRedCarpetNursing.com, was lots of fun.
It sucked up LOTS of my time, and it attracted some eyeballs. Hobby blog numbers, honestly, a few million views a year. Fun! Yet not quite satisfactory. It was missing an extra something I couldn’t quite manage to define. So I took a break to find that special secret ingredient.
When was that? It feels like a long time ago, a long time…
I had to look it up, frankly. It was December of last year. I badly needed to reassess, focus, and at long last find my very own Real Deal, My Core Product. Without making it better, it seemed to me why bother? I can write in a paper journal for free and with much less work than it takes to blog, folks…. I needed a REASON WHY or it was No Sale.
It took a while, but it was worth it: I think I finally found my WHY! A mission of my very own that compels and excites me. A mission that matters. After so much work, frustration and paying dues, I’ve finally found it, the ALL THAT REALLY MATTERS that gives a project the soul it needs to live. That life mission…
There are plenty of loose ends – a truly silly long TO-DO list – and there will soon be a sister Podcast too – but that’s all mere details. Details don’t lead: they follow. They always follow the core ideas, don’t they? If not, they lead you anywhere and nowhere.
So what’s the core idea here? It’s…
Drum Roll, please!!! ……….
First, the theme, then the content.
Imagine a Three-Ring Circus under an old-fashioned tent… BUT with a Big Red Carpet under everyone’s feet. Nice! An extra-welcoming circus with a twist: everyone is in the audience AND everyone is a performer. We’re all equal, working together towards a worthy goal. Everyone can participate and play whatever role they choose. Some just watch, some teach, some entertain, all have fun. It’s all good. The first circus of its kind in human history!
I kept the comfy Big Red Carpet from the old blog – it feels almost like a family heirloom at this point – but Psych Circus is so much better than just that, so much BIGGER … a bigger vision and far better focused.
So that’s the theme. As for content, we’ll focus on three related topics:
- Mental health: both wellness and illness.
- Relevant skills: how to get along better because it helps us enjoy life and succeed. Also because in my decades of experience, most treaters need better people skills. All too many of us badly need better skills, to better serve our clients and better enjoy our work and thrive. Finally,
- We’ll help erase stigma forever because stigma causes much of the harm and even death associated with mental illness.
I’ve hired a Ringmaster for my brand new imaginary Circus, folks! It was easy because that Ringmaster is me. I’m an experienced treater, a husband of a wife with mental illness, and suffer from recurrent Depression myself. In fact, my wife and I first met on an inpatient Psychiatric unit, long ago.
Under my Big Tent, all are welcome. ALL: psych sufferers, caregivers, friends & families, curious folks, the ignorant, dumbass haters… everyone. ALL! Tickets are free. Free! I’ll keep it civil and fun, and we’ll all grow and learn together. Nice!
Regardless of illness, we humans desperately need to talk to each other more effectively. We need to learn from each other and bond, get along, communicate, make it better for everyone, kill stigma dead forever. We can, we must, and you know what folks? Do you? Here’s what, folks:
WE WILL!!! WE WILL HAVE IT ALL BECAUSE WE’RE GOING TO MAKE IT SO!!! WE INSIST!!!
And it’s going to be FUN too! Wait and see. It’s a Circus! Join us and make life better for everyone.
It’s arguably a disrespectful question, yet it seems to me exactly the question to ask.
Sure, I watched those Star Wars flicks so long ago. I watched Postcards from the Edge too. Still, to offer due disclosure as I present such a piece, I was never particularly interested in Carrie, her career or her life.
I’d very much like to say otherwise. In retrospect, I highly respect and appreciate her mental health advocacy and her survival skills. I hope to emulate her example in both regards, but I’m admittedly a fan after the fact, mostly learning about her efforts posthumously.
Carrie was a powerful mental health advocate. She took her own losses, struggles, and scandals under the ruthlessly bright lights of celebrity and put them to good use on behalf of countless others. Celebrity seems to me a tough gig, especially when it all goes horribly wrong and the spotlight focuses like a hot laser on faults and mistakes. Mental illness advocacy is also a tough gig: most people don’t dare to own their illnesses with the public or even friends and neighbors. Such risk stigma offers!
But imagine both at once: celebrity scandal AND mental health stigma. Wow! That’s a tough, tough, really tough gig! It involves some truly tremendous liabilities. Start with often potentially overwhelming symptoms of illness. Add consequences rippling through so many lives, then add the subsequent and inevitable blowback from so many directions. AND, to top it all off, consider stigma in deep and ever-deepening layers. Tough! It’s a wonder anyone takes it on, and it’s no surprise we see it rarely.
Under such circumstances, it’s against some rather long odds for someone like Carrie to break even, let alone make any progress. Yet from time to time it happens. It’s heroic, taken in context, and it’s the only way forward for the rest of us, masses of folks too beaten down, too frightened to make a stand on our own. We need leaders the same way armies of old needed leaders: not old folks to direct matters from a safe place in the rear. No, with mental health advocacy the only place to lead is from the front. wading into danger and calling others to follow. Carrie did just that. She waded in, took her licks over and over, and kept up the good fight as long as she could. It makes a difference, such effort does, in a way nothing else can. We need heroes: people willing to set aside their fear and take risks for others. Her death is our loss, yet she also leaves a legacy we can carry forward. Will we?
We need leaders the same way armies of old needed leaders: not like today’s old folks who run wars from a safe place in the rear. No, with mental health advocacy the only place to lead is from the front, wading into danger and calling others to follow. Old school! Carrie did just that. She waded in, took her licks over and over, and kept up the good fight as long as she could. It makes a difference, such effort does, in a way nothing else can. We need heroes: people willing to set aside their fear and take risks for others. Her death is our loss, yet she also leaves a legacy we can carry forward. Will we?
Carrie did just that. She waded in, took her licks over and over, and kept up the good fight as long as she possibly could. It makes a difference, such effort does, in a way nothing else can. We need heroes: people willing to set aside their fear and take risks for others. Her death is our loss, yet she also leaves a legacy we can carry forward. Will we?
Will we? I promise I’ll do my best. It seems the least I can do. It seems we usually assume events have some set meaning, but that’s not true. We give events most of their meaning in the way we respond to them. When it comes to mental health and stigma, clearly the most potent weapons in our arsenal are personal experiences. We desperately need stories, examples to show that mental health and illness and problems like any other problems people confront. People with mental illnesses are, in the end, people like everyone else. Stigma implies otherwise, and only real-world examples show how stigma lies. Each person’s unique story sets stigma back that little bit further. It matters!
Folks usually assume events have some set meaning, but that’s not true. We give events most of their meaning in the way we respond. When it comes to mental health and stigma, clearly the most potent weapons in our arsenal are personal experiences. We desperately need stories, examples to show that mental health and illness and problems like any other problems people confront. We need to show that we struggle: we fail and we succeed, just like everyone else. We learn, sometimes, and we gain wisdom from our struggles. People with mental illnesses are, in the end, people like everyone else. Stigma says otherwise, and only real-world examples show that stigma tells lies. Each person’s unique story sets stigma back that little bit further. It matters!et few take this path, and for good reason. Stigma isn’t just a word or an idea: it’s a potent form of hate that often ruins lives, careers, relationships. Because of stigma, the easy path, the safe path, the obvious path is to lie low, tell no one, hide one’s ugly hide your ugly embarrassing baggage, make the best of your life given all those dark secrets. That’s the path most of us take. So it goes.
Yet few take this path, and for good reason. Stigma isn’t just a word or an idea: it’s a potent form of hate that often ruins lives, careers, relationships. Because of stigma, the easy path, the safe and obvious path is to lie low, tell no one, hide your ugly embarrassing baggage, make the best of your life given all those dark secrets. That’s the path most of us take. So it goes. Heroes stand out because they’re the exception: rare.
Fortunately, a few heroes step forward. The safe path that they refuse, the overwhelmingly common path leads to no change, no progress, no learning or growth. It’s arguably the wrong path, the bad path. As J.K. Rowling’s wise wizard Albus Dumbledore put it so well,
“Dark times lie ahead of us and there will be a time when we must choose between what is easy and what is right.”
We surely must. Most of us take the safe path. Fair enough: I surely have done so for most of my adult life, and it frightens me terribly to come out of hiding. It’s comforting that others have broken the trail before me. For that, I thank and cherish Carrie Fisher.
Today seems to be Must Share Day…
A delightfully preposterous short film with the same name, Florent Porta does a great job rendering scenes of simple absurdity, where physics doesn’t do what you think it’d do. Brightly colored and fun to watch!
Aside from the lights, this entire gingerbread masterpiece by Christine McConnell is edible. Standing at over five feet tall, this painstaking work includes candy glass windows, chocolate shingles, and miniature green wreaths. Beautiful work, via DesignBoom: