Covid-19 Part Three: Coronavirus and Breathing

Breathing

The coronavirus gives breathing new meaning. I have a theory about it.

A week ago my most anxious patients had their symptoms under control. They would come in (yes, that was dumb on my part, seeing patients face to face, but we were five feet apart) or we used an app to discuss life, stress, relationships, work, play. We discussed everything but the novel coronavirus. Which is remarkable.

Everyone else, normal people, totally freaking out.

I attribute the absence of panic, the practical superior attitude of my anxious patients to therapy. They breathe, they work their muscles, all of the CBT we teach in this gig. They work the program.

But that was then, back in the first week, and now no one is absolutely cool. In the past couple of days everyone has talked of nothing else-- only quarantine and contagion, whether or not it is too late, who is sick.

Me, too. I panic too. Whatever anxiety we held in abeyance, denial, for as long as we could, well, we have officially lost it, along with our money. And the fear of dying, our worry about loved ones. It has us, even the most Zen among us. More than an eyebrow is twitching.

Therapists wonder if there will be a suicide epidemic. Money matters to everyone.

I had this theory that if we got sick we could still ignore it, not judge it, could distract with all kinds of things, hobbies, etc., breathing (the way the yogis do). But no! That won't work if we can't breathe,  if we can't exercise, can't get out of bed, which is what happens when we have pneumonia.

So that theory, watch it disappear. Coping is going to be hard.  All we have left are our usual devices, if we get sick.

We should call our doctor, On the telephone a primary care physician can tell us if we need to be examined or should go to an emergency room. Telehealth is covered by most insurance. Check that out before leaving home.

But if sick, and our anxiety is getting in the way of a good time, there are the following exercises to consider, standards in your average therapydoc's toolbox. To me it really is all about breathing and distracting, being creative and thinking less. But here are 2 suggestions.

I.

Visualization techniques are nice. Focus on encouraging antibodies to make an appearance, come out to play, those little packmen in your bloodstream that eat up foreign cells. Order them to gobble up corona cells.  Mind games are free. You can play if you have the virus, or even if you don't.  

II.

Focus on your breath. The method I teach my patients is just that, focus on  your breath. We all breathe anyway, so we may as well be mindful about it. Some people, when they get anxious, literally stop or slow it down. And we need it.  

There are 2 nice ways to go about about this.

1. Just as we attend to a throbbing paper cut, or anything else that our body ego seems to notice, like that nasty feeling we get gastro-intestinally when things don't move, pay attention to the air coming into the mouth, the nose, flowing into the body.

• Put your hand on your heart, notice your chest rising and falling in sync with your inhaling and exhaling. That's the power of breathing.
• Find your breath, either in the nose or mouth. Mentally attend to it, just watch, feel it, that and nothing else. If it is easier you can watch something while focusing on your breath, a nice picture perhaps, or a video of the sea, but it is the flow of your breath you care about, the wave of air that refreshes the body and the mind.
• Once you have found your breath, watch it for as long as you can. One minute is great. Three minutes, fantastic. A few times a day? Amazing.
• If you've been breathing through your nose, switch to mouth breathing and notice as air glides onto the roof of the mouth and the tongue, the teeth. Then as it disappears, goes where it is supposed to go, your chest rises.
• If you're breathing through your nose, feel the mucous membranes respond. They may feel cold. Watch as air carries inward to do the work of life.
• You don't have to do anything other than watch the show. You don't have to count, don't have to breathe more deeply. Just watch what is going on without any effort on your part. That's the ticket. It forces us to get greedy, to want more air, just doing that, and we'll inhale more deeply to comply.

There. You have mastered this.  You can and should turn to this fabulous, accessible, G-d given technique that actually works whenever there's a need to reduce anxiety, even depression. Practice it when you aren't anxious or depressed. Do it driving, do it doing dishes, do it while listening to your mother rant at you on the telephone to STAY HOME DURING THE CORONA CRISIS.

Alternatively.

2.  The balloon technique. 

 Notice the breath, your inhalation. After a few unscripted breaths, try to intentionally bring the breath to your belly, to fill it up like a balloon. You can even push your stomach muscles out to do that. Fill it up. Once full, suck in a bit more air and hold your breath 3 seconds.

Exhale slowly, imagine that balloon deflating. Stretch out the exhalation for as long as you can, and when you're out of breath, hold that pose for a moment.

Repeat.

To your health,

therapydoc

Oy vey, we're all gonna' die

Oy, Vey, We’re All Gonna’ Die

When my brother and I were young we would stay with my grandparents for a few hours after school. As we left my grandmother would bless us. 

"You should live and be well," she said. 

Powerful stuff, that. 

I can't remember if she put her hands on our heads while saying it— it's been a long time— but I have a vague visual memory of her face, her mouth, and her housedress. We are at her front door, leaving with our mother to go home for dinner. Gramma says these words, “You should live and be well.” Every. Single. Time.

What, from her own experience? Did she watch people die? Or did the words come from her grandmother’s hands?  Gramma passed away at 91.

But, as we say in my tribe, most of us are not on her madrayga. (rhymes with ha-tray-la). It is the Hebrew word for step or level. She and my grandfather only survived a pogram because the Czar let the Jews go on Yom Kippur, assuming they could afford the passage to America.

At the end of our visit, when my patients ask how I'm doing, I sign off by joking;

"Oh, you know. Just waiting to die." 

It always gets a laugh. It's the elephant in the room. I'm older than my grandmother had been when she blessed us. I'm in that vulnerable demographic. And people die from this virus.

I can say what I want about how healthy I am, how fit, how I can breathe as well as your average yogi-in-training (swimming for years has served me well), but to be honest, in my most rational heart of hearts I ask:  Am I, though? Will it be enough? What about that bronchitis last year?

But hopefully, yes, it is. And quarantine should help. So I tell them: You’re not in the office. I’m in WFH, work-from-home. We’re good. I’m not afraid (yes, I lie! I lie all the time!). We’ll get through this. 

In my community I'm not feeling the optimism. Like the rest of society they are hoarding food, and it is worse because of Passover. Passover has always been a time for making sure there is enough food that has no chometz, leaven. Passover preparation moves the needle for the rational and the anxious alike. Everyone is in the same rush to get ready. But we can’t even rush about from store to store as we once did, hunting down what we need for the holiday.  And we don’t like sending our children.

But back to the catastrophic expectation. Those of us who aren't worried about running out of food so much as dying think: It's that six degrees of separation thing. That's what triggers the fatalism. We know someone who had contact with someone, who had contact with someone else—  who tested positive!

Sometimes it's only two degrees of separation. But those words, tested positive, are foreboding, no matter how many degrees away.

As in, You’re next. 

When my sons were about 14 they were in Yeshiva, the local Jewish high school. Faculty and students did not speak Yiddish, not usually, but Yiddishisms can be heard in the hallways and these trickled home. My adolescent twin sons came home one day singing a Yiddish song they had translated to English.

Oy vey, we're all gonna' die.
Oy vey, we're all gonna' die.
Only Torah and only mitzvahs
Are gonna help us now.

The tune is catchy. My partner and I just recorded it, if anyone’s interested.

The boys had been learning a tractate of Talmud Berachot (A gemarah, legal book. Parsing it out berach rhymes with prof, chot with moat, hard ch) 

Again this is my recollection. Within the holy book we find the words, we're all going to die. It is something the rabbis talk about.

I'm sure I responded to the kids by saying  You don't need to be a talmudic scholar to know this. 

And yet, they sang the song over and over again, laughing until they cried. It is one of those tunes, quite frankly, that becomes an ear worm, catchy, contagious.  Pun intended.  

File singing, and yes, facing the catastrophic expectation, under Coping.

You should live and be well,

Linda Freedman

*mitzvahs  The good deeds commanded by the Old Mighty (my grandfather’s name for his Higher Power. There are 613 mitzvot in the Torah. 

PS   I'd be remiss if I didn't suggest this post by a blogger at Chabad.org.  (They would appreciate the song)  Check out 10 Things I've Learned About Life in the Midst of the Corona Crisis

Covid-19 Part One

This before we were ordered to stay home.

Like many people these days, I listen to podcasts. But they don't hold my interest very long, not unless there's something to learn from them. My tastes lean to rabbis, and people who have done research. A rabbi who teaches in a university, one who doubles as a professor, well, it doesn't get any better than that. 

All that to tell to quote from a prodigious podcast: Rabbi Dovid Katz on Jewish History Rabbi Katz almost always prefaces his conclusions by saying, 

Hey, that's just my opinion. Seriously. Just my thoughts on the topic, the matter at hand, what we're talking about here. Really. You know what I mean? My opinion. You understand. It's just my thinking. 

In other words, take it with a grain of salt, form your own opinions. You're welcome to go elsewhere, consult another rabbi, another historian. 

So that's the caveat here, too. Just my opinion. 

nobody's swimming lately

  Today I went to the pool and guess what? Nobody there! Nobody. Except one woman singing in the locker room. She said that people had been there earlier, but now they're gone.

She sang well. She seemed happy. And I, too, leaving the facility an hour later, felt pretty happy walking home.

That was today. Yesterday, as the news breaks about the virus, mass hysteria, fear of contagion, pressure to flatten the curve. All this for a virus, FD is quick to tell me. It feels like gloom and doom, the world is coming to an end.  Any money we thought we had? CRASH!

Coping skills are the order of the day. And all I can think is, ignore, ignore, withdraw, retreat, go into emotional-mental quarantine. When people panic, be the best therapist you can be. Don't. And tell them,

Life goes on. Stay in the moment. Feel reality, feel the present. Love it.

That's it, that's the mantra. Live life as is. Don't focus on Covid-19, unless it is to somehow lift others up. Don't bring people down. Like most things we fear, the virus has much well-deserved power. But there will be an end to it.  (Again, my opinion, what do I know?)

A steady diet of attention to this thing will, no question, bring us down. And yet, there is no escaping that, most likely. We will have to attend to it, we will, and we will all commiserate. We are, for once in a century, all in the same emotional boat.

The object is to stay up. Rally whatever serotonin we can. Stretch.

Because for most of us, as the Beatles sang many years ago,

Oh blah di, o blah dah. Life goes on bra.  Al la la la life goes on. 

We have choices. We can stay in the moment, live our lives in some happy fashion, and connect with people electronically (because, no doubt, the pool will close). The moment is different for everyone, but it is our prerogative to stay here, to feel it. Or we can future trip and worry.

As the rabbi might say, Therefore, choose life.

But that's just my opinion.

therapydoc

  

Covid-19 Intro

Time to resurrect the blog. There's a pandemic going on. People are anxious, not that anyone can blame them. What would a therapist have to say about it?

We could go into the various types of anxiety disorders, agoraphobia, generalized anxiety disorder, panic disorder. There's the fear of contagion, health obsessions. Hypochondriasis. Easily suggestible disorder (made that up).

Obviously obsessive-compulsive disorder. 

But let's talk about me. 

Let's say a person is still going to the health club or swims every day. Does she have a gambling disorder? The virus hasn't yet hit Chicago, but it is in Illinois. Just saying.

In my family no one would argue that we have genetic and experiential programming to lean toward anxiety. We're set up. We catch it from anything. 

So really I should be flipping out about the coronavirus, Covid-19, but I’m not. And it helps that FD is not. He had a patient with another type of Coronavirus, not 19,  who was very sick. We're hoping because of that we are both immune.

He treated it like he treats sick people and the patient is fine. 

Strangely enough, perhaps the most anxious/OCD person that I know isn’t flipping out either. I saw him yesterday and we talked about everything but coronavirus and it was liberating, at least for me. Him, too, one can hope.  (There's much to be learned from his therapy and why he is not freaking out. We'll get to that in another post).

Everyone at my office is talking about this, at least right now, no matter what the presenting problem: depression, anger, grief, anything. My mix is quite concerned about coronavirus, if not particularly freaked. We could talk about this phenomenon the entire visit. 

What is there that someone like me could add to the conversation that hasn’t been said already? Because frankly everything has been said. Am I right? 

Fact is, there is a lot to talk about. We want to know about the progression of the disease; we want to know if we are at risk; we want to know if we can travel; we want to know if we can send our children to school, if we should go to work, if we can go to work. Must we disinfect every doorknob, and on, and on, and on. Because of all of that, we do need to listen to the news; we have to get updates from television, email and social media. 

Every mention Covid 19 is triggering whatever latent fears. Our anxiety is triggered, if only a tad more. 

You would think that all this flooding would help, but it doesn’t! So what does?

I can't go into it now. They're picking me up downstairs and it isn't nice to keep people waiting. But let's say this. Let's stay present. And make the present good, happy. Do those kinds of things. 

And breathe. Any old way. More on that later.

Wow, it's good to be back. 

therapydoc

Better Things-- Seeing Ghosts

Pamela Adlon talking about Better Things

The holidays used to roll in and it would be impossible not to write about how they bring forward emotions we don't dwell on otherwise. Memorial Day is no different from Thanksgiving in this way.

On such days there's a breather from work.  We're happy if the weather obliges, anxious if there's a harbinger of family conflict at an anticipated reunion, or just sad that certain people aren't around.

On that note, in 2006 or 2007, I posted about what it means to believe in spirits. Google's Blogger, the host of this blog, tracks such things and would periodically reveal to me that of the hundreds of seriously rough, unedited essays, visitors hit on "Spirits" most frequently.  They search for essays on ghosts and spirits. Who knew? I didn't understand it.

But a television show — Better Things —clarified. Better Things is a production of Pamela Adlon and Louis CK.* She produces, writes, and acts the lead, Sam. The show feels biographical, almost anthropological as a recording of a particular tribe: a family, their lives as experienced within a particular culture. The stress associated with single parenthood, in addition to being the child tapped to stay on top of her own mother is familiar. As good media can do, Better Things brings us Ms. Alden's stories, shows them to us, so much so that the word "sandwiched" isn't necessary in the dialogue.

The show is a guilty pleasure despite the cringe bathroom humor, an entire episode dedicated to colonoscopy prep; most others replete with uncensored references to sex. Expect that, most episodes treating sex for what it is, especially to teenagers. It is not a pretty slice or interpretation to those of us who believe in love-making.  The language of the show is always coarse, direct, graphic.

So what's the pleasure? 

The stark truth of the relationships reels me in. When this show gives, it gives all the way, and you want to take every moment of the gift.

SPOILERS IN THE NEXT 4 PARAGRAPHS

In one of the most moving episodes, The Unknown, Sam is summoned by her daughter to come upstairs; she's sure there's a ghost in the house. Sam checks it out and oddly enough there's an indentation on the seat of the bed. Sam can't help but comment on the similarity of the size to her father's derriere. He passed away young, around 50. He was her rock. Her mother struggles with dementia and you wonder if it is alcohol related, sense she has always been as she is, British, detached, on her own planet, yet wildly popular among her peers.

Sam is driving in the car and Dad pops up in the passenger seat, comments about a man she is seeing. She has to think about the observation. She never would have looked at it this way.  I think, will my daughter, my sons, do that? Think about what I would say about something after I'm gone? It is hard not to ponder this.

Sam is honored at an event at her father's club  (Lions, Masons?) as his stand-in. After accepting the award, sitting at a a bar with  his best friend, the "best friend" hits on her. She leaves as he protests. On the way out she sees her father in a chair in the lobby.

They high five. 

The Eulogy Episode- so indescribably touching I refuse to spoil it. Too moving, healing, full of the love rarely expressed while we're alive. We wonder what people will say at our funerals, but wouldn't think to get a preview. Some of this episode is up on YouTube, but don't do it. See the show from the beginning or it isn't meaningful. And it is a meaningful enactment of how healthy people relate to one another.

Rereading this, it would seem all I care about are shows about dying, friendship, parenting, and being parented. Could be.

therapydoc

*The producers reached an agreement after the accusations against him of sexual harassment so that Ms. Adlon could work without Louis CK on the set, or maybe not as an active partner, either, pretty sure.

Envying the Rich

Matzah the poor man's bread

I don't remember my parents ever envying the rich, only enjoying their friendship-- my father, anyway. It made him feel rich, golfing with someone who had a medical degree (in his day medicine meant money) or playing poker with a man who didn't mind losing a few dollars by midnight, when the men went home to their wives and lied that they came out even. The night after a poker night would be a good time for me to hit my father up for pocket money.

My parents would return from a destination wedding and regale us with the details, simply happy to be a part of it. I do think that they were happy with their lot, that they were ash-rei b'chelko (rhymes with posh-tray-b'-well-tow, happy with one's portion), albeit ever striving for more. Both grew up poor. My father liked to tell me that he picked feathers and lice off of chickens at his first job in America, immigrating from Poland. (He had stories about being the new kid in class, speaking no English). My mother, born in Chicago to immigrants, describes not having a nickel to buy a coke at the local "drug store" like the other girls. She really was envious of them, come to think of it.

No matter. I'm more like my father, maybe, one of those people who marvels it what others have, what they buy, and think, This makes them happy? All I want is to have enough left over at the end of the quarter to pay the IRS. Someone once said to me, I love paying my taxes. Some of us get that.

How does one get to a a point of no complaint?

I don't know.

I liken it, however, to accepting things as they are, not exactly mindfulness, but surrender. The winter in Chicago, for example, simply having the wherewithal to get through it, this is the key. Then just when you think it is over, it snows in the last days of April, and you're not happy, but you do what you did all winter, get on with your life.

We just finished Passover, which is like moving out of your house then moving back in. You clean it first, top to bottom, everything, your ovens, refrigerators, remove every vestige of leavening agents or things that have yeast (or flour!) from your home and then settle into the holiday and eat matzah for 8 days. It is a tough holiday, tough on us physically, gastro-intestinally, too. We bring up Passover dishes and pots and pans from the basement and eat off of these for the week. Then we pack them all back up and bring them back down after the holiday, put the kitchen back with the everyday appliances, the food processor, toaster, coffee maker and microwave tray to get our lives back in order. During the holiday we didn't use them, wouldn't risk contaminating our unleavened food. A crazy holiday.

Exhausting.

Rich people go away to resorts and eat food that other people have cooked for them, supposedly under the close supervision of a rabbi. Friends of mine, rich or not, won't do this, fearful that the rabbi isn't watching very closely, fearful of breaking the law, eating something that perhaps isn't even kosher, let alone, not kosher for Passover.

The holiday accomplishes one thing, however, rich or poor It makes us happy for what we have. The matzah is what it is all about, the poor man's bread. It is emphasized in the telling of the story of Passover, and naturally, all week long with butter or cream cheese. In the biblical story, the Jews, running from the Egyptian king, the Pharaoh, who is about to change his mind about letting them leave slavery in Egypt, are commanded by their Higher Power to take their dough, not wait for it to rise (as I am doing right now) and leave Egypt immediately.

It turns out that unleavened bread, difficult to digest, is filling and would go a long way during that long trek from Egypt, the perfect camping food. The Jews would theoretically be going camping for a month before they reached their destination.

So much more to the story, but suffice it to say that matzah is and always has been the Poor Man's Bread, and the reason it has so much to do with Passover is that we are to be reminded, when we eat it, that not only were we poor, but we were slaves for over two hundred years in Egypt. Being poor, we are reminded for one week out of the year, having no real bread, is where we come from, all of us in my tribe.

We may feel like slaves every day as we head off to work early in the morning. We may resent those who don't have to work hard, who don't have to rob Peter to pay Paul, and for sure, we are likely to be envious of the heated sidewalks of acquaintances when we're forced outdoors, shovel in hand. But to a great degree we are free. We have free will. There is so much that we can do as our own boss to a  large degree.

Leavened bread, wheat bran

Why are some of us less content with what we have than others? I think it has to do with hope, more than anything. If we have that, if we can keep striving, trying, plotting, planning, creating, whether or not we think it will get us anywhere, we can dream, and take pride, and hope for a better tomorrow. It is when we lose that, when we cannot push on, that the things that others have reminds us of our ultimate powerlessness. And we don't like that.

Religion being a great equalizer, we can pray together, rich and poor, and connect, occasionally socially, work on projects for the common good. Some will even play poker, golf.

Last night FD swept up, but I just finished putting away the toys and vacuuming up the last of the crumbs of the holiday this morning. And I thought: I wouldn't trade a day it with family, with all of my children here at my table, or playing Chess and checkers, Mancala and Connect 4. That's rich.



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One Teenager Killed Himself. Six More Followed

You may know that therapists run differently, some falling into two camps. In one they are interpreters who divine meaning that may or may not be there, from words. In the other they are more client-centered, assume that the meaning the client attaches to her words is the one that really matters. The rest of us, like me, are a combination of both. But if you tell me that you think the sky looks green, then I'm going to go, Wow, she sees a green sky! What else is she seeing up there?

Snowfall April 14, 2019

I get to the office on Sunday morning about 30 minutes early because the Sunday bus is reliable at 8:00 a.m., but not necessarily at 8:20 and I start seeing patients at 9. Taking the earlier bus also allows me time to pop into Tony’s to buy some produce, and I always buy too much to carry on foot comfortably. But that's just what happens. 

So when I do get to the office I’m a little out of breath, but not cold--  even though it is snowing on April 14, 2019, at this writing, a wet sleet-like nasty snow that will turn into big fat snowflakes in about an hour.

And I think, wow— I really did master winter this year— probably because of the fashion invention, leggings.  Under a warm skirt, these are phenomenal.

Layering up is a metaphor that we might apply to surviving dysfunctional families and/or dysfunctional work environments, too. People layer up, defend with coping strategies against the craziness. The healthy ones hide out with friends, confide in them or not, or they play sports, slap paint on a canvas, write songs, journal, study, create. They tend not to need therapy unless they can’t sleep or feel too much sadness or anxiety, or powerlessness and unworthiness become overwhelming. The unhealthy ones drink to much, use drugs (the wrong ones or too much of the controversial substances, pick your poison), identify with the aggressor and bully others to feel better about themselves, that insecure narcissism we see in so many successful people, oddly enough. 

Some kill themselves. Yesterday’s Wall Street Journal ran a story about copycat suicides— six teenagers. No longer with us.

How do kids survive the world we’re living in? How do they layer up? How are they handling the attention deficit they know they have that makes concentration in school and at home so difficult, the known cause that constant electronic bombardment (only during waking hours), all that too much information consumed in the form of entertainment, games, social networking, even on television? Not that this is a cause of suicide, but it's a problem. And the violence, no question. A problem. 

We have to talk about this. 

Okay, my 9:00 will be here soon. So not now.

therapydoc