The Worst Enemy

I have become increasingly convinced that it is not external issues that create the greatest amount of stress and pain in our lives. It is the little voice in our heads that goes on and on, reminding us of our failings, threatens us with worse case scenarios, rehashes old hurts, and sabotages the holding of pleasure in our lives.

Have you ever talked to someone in whose presence your concerns felt respected but greatly diminished? Then as soon as you left that person, your own thoughts pulled you right back to your fears and panic? It actually happens all the time--most of us do this on some issue, with some individual.

This became clear to me last week as I took my mother to the doctor. She had been seeing a young, disheveled MD who never seemed to have read her chart and for whom she had to wait a minimum of one hour in the exam room. Oh--did I mention that Mother was seeing him for hypertension? Needless to say, when he finally did appear, her blood pressure would be soaring and she would be livid. So after nothing about his demeanor or helpfulness changed, I transferred Mother to a smaller community physician's office to see an older doctor who specializes in hypertension. He was delightful. His comments were directed toward Mother, not me, which was how it should be. He took time and heard her discuss her health concerns, my father's recent death, and her feelings of despondency. This doctor could not have been more gentle and kind. He patiently and calmly explained that sometimes people with hypertension need two or three medications in small doses rather than one medication at high dose because each medication has different physiological effects. Mother nodded with enthusiasm, even though on the way to his office she had fumed about having to take more than one pill per day. He discussed her Advanced Health Directive with her and told her to take time to speak frankly with me about what she would like me to do if she collapses at home or has a heart attack in a public place, etc. He helped her get the proper lines signed to make it a legal document. I was delighted.

We went back to her apartment and I filled up her weekly pill dispenser with the exact doses of the three pills she is to be taking. Mother was happy and relieved to have such a fine, patient, and personable physician and seemed contented with life and her circumstances.

This morning she woke up with a full head of steam. She can't get her blood pressure machine to work properly, she doesn't want to sit for 10 minutes before taking her blood pressure ("It feels like punishment to have to sit still for that long!"), and she doesn't want to have to take "all these pills." "I just don't think it's worth it to go on," she lamented. "When I have to deal with all of this, I just wished I could drop dead."

I couldn't believe my hearing. She had just had a wonderful weekend--two concerts that had thrilled her, all day Saturday with us, Thursday cooking and shopping with me, and several meetings Friday. Now she despairs of life.

I believe there is a voice in Mother's head that suggests that she can't survive without my father doing everything for her; that any pain she experiences is a harbinger of imminent demise; and that the worst possible outcome will be realized about whatever issue she is concerned over. Mother has long suffered from anxiety. She has all the symptoms of Generalized Anxiety Disorder (GAD). We intuitively knew Mother was high strung and jittery, when we were children. It was what made it so much fun to tease her by telling her preposterous stories about ourselves, or to suggest that perhaps one of us girls was pregnant or was in trouble with the law. Mother would all but go into orbit whilst we tried hard not to laugh. Even after we assured her that there was no truth to our assertions, she remained so physiologically aroused that she couldn't calm down. She would fuss and fume for some time about our comments. We found this to be highly entertaining.

I now understand that this is not a fun mental process to have. If Mother ever does take her own life--and I've been concerned in the past that she might--it will probably be because her anxiety and depression have overwhelmed her. When we become worked up about something, our bodies have an immediate stress response. We may feel that flash of adrenalin and be unable to stop the shaky feeling, much as a person would have who had a near miss of an accident on the freeway. When that happens, you have to pull off the road to get yourself back under control: the jitters continue, the rapid breathing, and shock doesn't go away for some minutes.

Our bodies have similar responses when we become concerned about intangible fears: what if the stock market crashes again? What if I fail my test today? What if my husband breaks his neck? The stress hormones flash through our bodies and we respond accordingly. This is because our bodies don't know the difference between being threatened at gunpoint by a slavering lunatic, and recalling a devastating emotional insult by someone at work. We get worked into a tizzy and react to those around us accordingly.

I used to have a roommate whose panic was always surprising to me. When we had a major earthquake at night, we'd all three race out of our beds and stand in our

doorways for protection. Penny would begin to gasp and turn ashen. Even after the shaking had stopped and we had gone back to our beds, she would be pacing about, visibly trembling and very upset. I later found out that she had mitral valve prolapse, which often causes panic responses that don't have very rapid resolution. It was a physiological issue that initiated the panic. Then the voice in her head made her ruminate on the experience until she was sure she was doomed to die. It was very interesting to observe back then. She also had an anxiety disorder: Obsessive-Compulsive Disorder.

So as I sit and wait for Mother in the dentist's office this morning, I wonder what story her head will tell her later today about having to have a crown replaced after extensive drilling, and numbing of her jaw. Will it make her blood pressure go sky high again? Will this make her despair of life once again, because she is so frightened that she has become overwhelmed?

Writing this down is actually a way for me to avoid becoming panicked about her panic--of putting to rest the voice in my head that says I'm not doing enough for her, am not a good enough daughter, can't prevent her from harming herself, can't make her happy all the time.

We are our own worst enemies sometimes.