When Crisis Strikes

SOMETIMES I SEE A YELLOW bucket. No, I’m not one of those psychiatrists who experiments with LSD; it’s just a visual thought that makes itself present in the space between me and a patient from time to time. The bucket is wide and very tall, filled with water. It represents my patient’s tolerance for stress, and this picture comes to mind when I sense it full to the brim.

Many of us have a large capacity for dealing with stress, but once we reach capacity, the addition of even one tiny drop will spill over the edge, resulting in what scientists refer to as losing our shit.5 This can cause a lot of confusion for the person who just handed us a single drop. And we’ve probably all lost it at some point over something really small, like the dog getting out, the milk being left on the counter, or someone squeezing the toothpaste tube from the “wrong” place. These “nothing” things, when one’s stress bucket is full, can cause a cascade of emotions to spill over the fragile edge of the bucket, confusing and alienating the people in our lives.

At the bottom of the bucket is a spigot. When we figure out how to open it, we can start emptying some of the water from the bottom of the bucket, gradually creating more space for new stuff by clearing out the old. In this way, we increase our capacity for dealing with life’s drama. It’s like letting a little air out of an overfilled balloon or allowing that overly stretched rubber band to relax. This is Step Four. Following the intensity of action in Step Three and giving your crisis the middle finger, it’s time for the ring finger—a symbol not of strength or power but of intimacy. The ring finger is personal. Now we turn inward.

Sometimes I think self-care is the new swear word in psychiatry. In my office, the term elicits everything from blank stares to eye rolls and cringes; long gone are the days when I’d mention it and someone’s eyes would widen and face light up, as if something exciting were about to happen. Self-care has been hijacked by marketing firms to sell us everything from moisturizer to products for thinning hair and nasty toenails. For some people, it has become synonymous with a day at the spa or specialty health and beauty products you can only buy from your friend’s Facebook page. But self-care isn’t fluffy pampering or consumerism, and it has nothing to do with having a bikini wax—or trimming nose hair (but seriously... do that).

One week, three young adult siblings came to see me. Each had an individual appointment and was accompanied by the father, who had arranged for his kids’ consultations. He had identified concerns with each—one used cannabis, one was stuck on video games for hours every night, one was the nicest young woman on the planet but had a mean temper. Dad came into the beginning of each appointment to share his concerns before leaving us to it. On the third day, I finally asked when he was coming to see me. My question surprised him, and he replied his kids were his priority and he wanted to get them sorted first. However, I was concerned. Over the course of the week, I had seen him several times, and each time he looked more pale and exhausted than the time before. He dressed smartly and wore a confident façade, but he wasn’t fooling me. When he didn’t come in, I made a bold decision and called him. Something was wrong.

He surprised me by agreeing to come in for a session. On his intake paperwork, he listed anemia as a past medical problem, so I asked him about it. “For some reason my hemoglobin runs low,” he said, “and when it gets too low, I have to get blood transfusions. My doctor is on top of it.”

“Are you on top of it?” I asked.

He paused, then said, “I’m due for a transfusion, but I wanted to bring my kids here first.” He admitted that his hemoglobin had actually fallen dangerously low and that his doctor had ordered him in for a transfusion, but he thought it perfectly normal to fly to California for a week so his kids could have these consultations with me first. “They’re my priority.”

I was both incredulous and alarmed. “You can die from low hemoglobin,” I told him. “You can have a stroke, heart failure, organ damage. If you don’t take care of yourself, you won’t be able to take care of your kids.” He promised to see his doctor right away.

A few weeks later, I called him to check in. “I have to drive the kids to their games. They have homework. Every night, I cook dinner. My wife travels for work. I just can’t go in!” I could hardly believe my ears. This man was allowing himself to die a slow death because he wouldn’t stop the busyness for one afternoon to get his transfusion, putting his future in jeopardy. Which is really more important: one afternoon of basketball or a future playing with your grandkids?

Although this man’s situation was extreme, many of us have some version of it in our lives during a crisis. We put off taking care of ourselves because it feels like everything around us is a fire that needs to be put out. Kids need to be fed. Endless laundry needs to be put away. The dog is encrusted with a mysterious goo, and when asked about, it the children all suddenly have amnesia. The last thing on our minds is self-care. It sounds like a time-sucking luxury we just can’t afford.

Step Four is about real self-care. It is a time of reflection. Simplification. Of evaluating how we treat ourselves. Setting intentions. Letting some of the water out of the bucket. It’s the private journey of self-intimacy, which is an important part of moving forward through a crisis.