Self-Care for Caregivers: Tips and Tools Chapter One

Every caregiver needs a toolkit to prevent or remedy compassion fatigue.  Here's several ideas for self-care to keep you in balance.  Some require time, practice, or props; some can be done in seconds during a meeting. Many of these have been covered in previous blogs and portions are reprinted or linked below.  The best of what I know is in these hyperlinks; it's a lot to read but I hope you'll dip in.

Managing the Monkey Mind 

     Oh the nerves, the nerves; the mysteries of this machine called man! Oh the little that unhinges it, poor creatures that we are! --Charles Dickens

 Don't suffer twice. When we worry about something in our future, (and there's nothing to be done about it) it's a lose-lose situation. If it happens, we get to suffer twice. If it doesn't, we worry for nothing.

 Mind your stories. A Swedish proverb says: Worry often gives a small thing a big shadow. We can tell ourselves pretty alarming stories that have no real basis in probability. Check for facts. How many times have planes crashed at PDX today? This week? This year? Chances are that same pilot who's already landed the plane safely 8 times this week will also do fine today. 

Take a breath. When we are fretting, we are often literally holding our breath. We don't breathe out all the used up air, and we end up in a bit of an oxygen deficit-- which does nothing to soothe our anxiety. Try "box breathing"-- take as much time to breath out as in, and make sure to pause for a reasonable time between inhalation and exhalations.  For more info on the power of breath, click here.

Get some distraction action. Since what you feed (your mind) grows, look for healthier places to invest. Listen to some music, taste a lemon, do some art.   Here's some info on how music can heal:  http://www.janasvoboda.org/2011/01/resolution-24-make-joyful-noise.html

Fire up a more logical part of your brain. Think of your brain like a power grid. If one part-- say that pesky amydala, which is all about emotion-- is all lit up, chances are the areas that access logic and reason are a bit dimmed down. Shift the resources by engaging in a few minutes of algebra, or even sudoku. Firing up those neurons will take a load off. 

Accept your emotions and remember they are transient and (in their moment) valid, so judgment isn't helpful.  (More here).   But feelings aren't facts-- or based on them-- so you don't have to react to them. Let them rise up, use them as data, and let them pass.  

Befriend your body.  Give it some rest, good food and some exercise.  Exercise is a chance to dump all those fight-or-flight chemicals that have nowhere to be of use, and it's neurogenerative too-- rebuilds those brains cells that stress kills off. 

Use Visualization:  here's two I like.  1) Imagine yourself as a mountain, fully rooted and stable, big and strong.  The yoga pose Tadasana is all about this rootedness but I find just imagining the way I feel in this pose is nearly as good as doing it-- and a lot more reasonable if I'm in the middle of a tense meeting.    2)  Imagine you have a Teflon force field and all that negative stuff just slides off away from you.  Don't pick it up!

When we are stressed, our self-talk and thinking can spiral in bad directions.  Here's an except about getting that in line.

Don't feed Ethel.

Most of us have a loud and annoying bully in our head who tells us Bad Scary Stuff.  I've decided to name it "Ethel".  Please forgive me if you are or have an Ethel in your life that you love.

Ethel says things like:  "You can't do it.  You're a loser.  Why try?  You don't deserve to (fill in the blank:  be happy, healthy, out of debt, in a good relationship)."  She tells lots of scary stories with an authority that is quite convincing.  Ethel gets bigger and stronger every time you listen to her.  

When that doubting voice shows up, don't even bother talking back.  It's OK to talk to yourself.  (Tip:  Unless you're alone, don't do it out loud.) Tell yourself: "That's just Ethel, doing her deal."  Tell yourself some facts, like "I've been scared before and done fine anyway."  Or "I don't really know how this will turn out, and I won't know anything more if I don't try."  When Ethel has no attention, she tends to wander off.

Make use of the healing power of nature.  It's restorative, restful, oxygenating, and less impinging.  Take a walk in a forest, lay on a beach, wander a meadow.

Lighten the heck up! Yes, life is full of suffering.  As Buddha says, One life: ten thousand joys, ten thousand sorrows.  Make sure you are getting the joy part in.  Read more about play and laughter-- then get some.

Don't forget the importance of community.  On the whole, Americans have never been lonelier than we are in the "connected" age.  Online isn't enough.  We need real people who can really see us and accept us for who we are, warts and all.  We need touch (more on this in a coming article), witness, and to know that if we need tangible help there is someone who will.  If you are feeling isolated, know at least that you are in good company and there are others like you wanting to connect.  Take the risk and reach out.  

Reset your happiness baseline by shaking up your routine and practicing gratitude.   Learn more about happiness research here  and in this blog on Happy Factors.

Remember that YOU COUNT TOO!
Most natural caregivers cannot help but attend to the needs of others.  They would never intentionally neglect a being in need of attention, love and kindness.  Except for themselves. 
They-- you?-- need to remember the Silver Rule:  Treat yourself as you would have others treated.  And as Thom Ruttledge says, remember "You are not an exception to the rule that nobody's perfect."  So give yourself a break, some love, a kindness.  Acknowledge and accept your human limitations and feet of clay.  "Put on your own oxygen mask before assisting others."

And that's important.  Because if you burn out, there is one less person who to help.
Take care of yourself, sweetheart.
-----
photos for this blog taken at this year's Oregon Country Fair, now in its 42nd year of creative community.

SelfCare for the Caregiver: Compassion Fatigue

 Last week, I was in Kansas City talking with the staff of a large animal shelter about compassion fatigue.  Wayside Waifs was started in the 40s by a woman who purchased land in the hopes it could be resold as a farm after the city's animal welfare problem was solved.  Then, the shelter operated in a 3000 sq foot building.  65 years later, it's bursting at the seams at 30,000 square feet, and adopting out 5000 pets a year.  Despite aggressive campaigns on spaying and neutering and other aspects of responsible pet ownership, the problems of animal abuse, neglect and abandonment are not likely to be solved anytime soon.  

Animal shelter workers and other workers in fields where needs outweigh resources, and where empathy is a crucial part of the call to service are at high risk for compassion fatigue.  Like burnout, CF can suck the joy out of doing important work.  But while one can burn out at any job, compassion fatigue is associated with jobs in which the worker is exposed to suffering and trauma.  Also known as secondary traumatic stress or vicarious trauma, one doesn't have to be the victim of life's precariousness to feel the effects of witnessing it.  Hearing about or seeing seeing suffering of vulnerable beings (yes, animals too) triggers sympathetic reactions in our own nervous systems.

Not surprisingly, the persons most drawn to caretaking jobs tend to be highly sensitive.  I'd guess they are way over-represented in the Troublesome Trifecta category-- those folks who have Big Radar (take lots in); Big Sensitivity (feel it deeply) and Big Brains (analyze/ruminate a lot).  Such traits are common among people who rate high in anxiety, and as noted in the TT article, it's estimated that anxious predisposition occurs genetically in about 15-18% of us.  The biological advantage is that these hyperalert and vigilant types will notice environmental dangers and thus avoid them, staying alive long enough to reproduce and keep that gene in the pool.  The downside, of course, is all that feeling and thinking can be exhausting.  Faced with a particular trauma, the brain has three routes of defense:  flight, fight or freeze.  When there's no one to beat up and nowhere to go, freeze eventually becomes the default.  And that can translate into Compassion Fatigue.

Freeze is misleading-- it can be paralysis, but often is just of an emotional zone-out, a sort of flight of feeling.  It's basically dissociation:  you are of the world, but not in it.  Like all defenses, this can be handy and helpful.  And like all defenses, it can become habitual and limiting.

It's well known in therapy world that "exposure" is the treatment of choice when dealing with phobias.  If for some reason your brain fires up wildly every time, say, you are on a bridge, a cognitive behavioral therapist will gradually expose you to bridges (first imagined, then represented, then real) until your brain figures out there is no real threat there. And in fact, there really wasn't a threat in the first place, or if there was, it was isolated and unusual.  You can also desensitize to more visceral and universal threats, such as the sight of blood, vomit, broken bones-- ask any ER worker. 

But for the ER worker, the first responder, the child abuse worker, and others, there can be a cost to the exposure.  The brain has to protect itself.  It can compartmentalize and figure out all the ways the situation doesn't apply to it/you.  It can try to solve the problem by working harder at caregiving.  It can check out.  All of these are effective in the short run, even without our conscious minds engaging-- in other words, we don't realize that's what we are doing.  But without some conscious intervention, we eventually get tapped out.  Brain says-- enough.  I can't take caring about all this anymore. And then we either stop caring, or we stop working.  Sometimes we stop working before we quit our jobs.  That's burnout.  Sometimes our bodies stop for us-- giving us the break we will not take for ourselves.  None of these is a good outcome-- not for us, not for the beings we set out to serve.

In compassion fatigue, there is burnout, but there is also emotional numbing, or intense emotional triggering and dysregulation.  Watching suffering activates empathy.  Persons who are more empathetic are more highly activated and affected.  It's not just in your mind-- it's in your body.   The brain has mirror neurons that activate as if one is engaged in an activity even when only observing it.  For an obvious example, watch what happens when a man sees another man kicked in the testicles.  That wince-- and sometimes grab-- is instantaneous.  And if you happened to have the observer in an brain scanner, you could watch portions of his brain light up with activity.  Interestingly, and logically, persons with higher levels of empathy seem to have more of these mirror neurons-- their "lighting up" in response to observing pain in others is more intense.  They are literally feeling your pain.  Here's one paper on this phenomenon (there are many): StuartDerbyshire/Pain_sensation_evoked_by_observing_injury_in_others


Symptoms of compassion fatigue are myriad. Reluctance to engage, irritability, compulsive use of drugs/alcohol/shopping and other numbing and distracting agents are a few.  For a more complete list, see compassionfatigue.org. 

Risk factors are myriad as well.  As you can see, the very people drawn to being caregivers are the sorts that do not screen out others' pain well-- the very reason they are led to try to reduce it.  Many have come to their empathy through personal trials and suffering, which has enriched their capacity for compassion and understanding.  Unresolved personal suffering, however, increases the risk of burnout and CF.  And watching others' suffering can change world-views.  As a crime detective once told me, "I see a small, very bad portion of the world way too often and way too close.  And it's hard to remember that's not the way the whole world is."


The long and atypical (rarely 9-5) hours of most service jobs, the incredible feeling of personal responsibility (“I should have done more!)  often coupled with little agency or authority, and the inevitability of poor outcomes in caregiving jobs are part of the unavoidable risk factors that can lead to Compassion Fatigue without support and intervention.  There is also the physical toll of brain’s instant chemical response to hearing/seeing threat without having the avenues of true flight or fight to make use of them.  Such chronic exposure to stress chemicals can lead to real illness.

In the next blog, I’ll talk about ways to mediate these very real risks.  We want caregivers that care—that’s a win-win.

Getting Real in Relationship and Communication-- a small start

A Boar in a China Shop:  looks like trouble.

Thanks to colleague and anxiety genius psychiatrist Dr. David Hart, I am enjoying the exploration of authenticity in communication within personal and professional communication.  He introduced me to FAP, aka Functional Analytical Psychoanalysis, in which the relationship between therapist and client is but a mirror to client's extended relations out of the office.  Old news, right?  Psychoanalysts have explored that for decades.  But in FAP, that dialogue is happening live in vivo, not just in the shrink's heads or notes.  I've always said I'm an open book for my clients-- if they are wondering what the heck that last comment meant, or why I'm encouraging a certain homework, I encourage them to just ask.  But now I am mindfully (hopefully!) censoring less about counter-transference, and saying things like "When you do X, I feel Y rise up, and I wonder how often that happens for others in your relationships".  I am encouraging them to investigate and take accountability for their impact. That's hard to hear, but can be powerful insight. I try to do a good job of acknowledging my own filters; eg I could be way off.  And I want to be respectful and indicate understanding for the behavior coming from a positive intent.  But we are all defensive of our personal versions of reality, so it's hard work, for therapist and client.

For better or worse, it's a loaded endeavor when one chooses to risk being respectfully honest about one's internal reaction to what's happening in real time.  Perhaps my grace for that will improve with practice.  Bear with me and extend trust my heart is in the right place and I will struggle through it in partnership with you. 
To hone my skills, I am also reading Susan Campell's
SAYING WHAT'S REAL: 7 Keys to Authentic Communication and Relationship Success, another recommendation from Dr. Hart.  It's important to me to keep learning if I want to teach.

 Next week I'm giving workshops on compassion fatigue to Kansas City animal shelter workers.  Tonight I watched Sundance Award Winner documentary "Buck" and it's a powerful piece of film.  Head to the Darkside for a beautiful example of a person finding and living vocation (Buck is a gifted horse trainer) despite a difficult childhood.  There is much to be learned in here, and you don't need to know a thing about horses to get it. A lot is about communication-- checking to see you are clear and consistent in what you say you want from the other.  Applies to horses as well as people.

Speaking of gaining awareness of of impact-- I continue to obsess about the multitudes of subtle and chainsaw-type impacts of Letting Go of Nose.  Found this article tonight and love this paragraph.  Author Jennifer Boyles has likely been anosmic from birth, which is a different ballgame from those of us struck down after years of taking the olfactory world for granted,  But she has some powerful things to say.  I particularity related to this paragraph:

"While anosmia is not as life-altering as blindness or deafness, I am still missing one of my five central senses. Many people don’t take this seriously. They say that I’m “lucky” because I can’t smell car exhaust, dog poop, smelly socks, etc. True…but I also can’t smell dangerous things like smoke, burning food, spoiled food, noxious fumes, gas leaks, and other danger signals... Besides, at what expense am I “lucky” to be in a dog poop-less world? At the expense of flowers, perfume, candles, and so on! Is it worth it to not be able to smell dog shit if it also means that I can’t smell baking cookies? Of course not! And nobody would say to a blind person, “You’re so lucky you can’t see. It means you don’t have to look at garbage, dog shit on the sidewalk, and polluted rivers!”

If you get a chance, check out her honest and thoughtful blog here:   http://www.jenniferboyer.com/main.html.
She's a wise soul.
Jana

Picky Eaters: Spoiled, Weird or Simply Supertasters?

persimmons:  love em now!

You may know one:  a friend or relative that turns their nose up at the dish you've lovingly prepared.  You may be one:  afraid to accept an offer to dinner because you don't want to offend the host by picking at your food.

I was one.  As a kid, I ate peanut butter and jelly sandwiches for more meals than I could count.  Here's a short list of the foods I would not get near before adulthood.  Pizza, tacos, any Italian or Mexican outside of crusts and tortilla chips.  I'd have spagetti, but only with butter.  White rice with sugar and milk for breakfast, but if you added anything else to rice, I was out of there.  Salad was too "mixed up".  Same with casseroles, meatloaf, all Chinese and Japanese foods-- anything with more than a couple of ingredients.  I couldn't stand mayonnaise or salad dressing (still can't-- well, that may be changing thanks to the noselessness deal); olive oil was much too strong.  I had my first slice of pizza (cheese only, of course) at 20, and my first burrito at 21.

A couple of decades later I was a nearly full blown foodie.  There were still things I couldn't bear-- the smell and taste of coffee, even in desserts; olives in any form.  But I loved, or maybe learned to love, exotic cuisines with all their layers of taste and fragrance and textures. My weight sure tells the difference-- I was 115 lbs when I graduated high school, and it wasn't anorexia.  I just didn't like most food.  But boy, did I learn to!

I have a niece who's just starting to expand her palate as she nears 20.  For years she lived on white rice, egg whites, plain noodles, american cheese.  She's still not a fan of most fruits.  Like me (ok, a former me, and if you are lost, read the last two blogs) she's a super-taster.  And for those with hyper-developed olfaction and taste, foods that perfectly palatable to others are wholely horrible to her.

RoadKill Birthday Cake:  Thanks, Rosie!

There have been some informative articles recently about picky eaters.  Long thought to be a childhood problem, adults are coming out of the white-food closet to tell their stories.  There is even a website devoted solely to information and support: pickyeatingadults.com/. 

True supertasters have a lot more papillae (taste-bud structures) than the average Joe. They taste bitter flavors with a much higher, and less pleasurable, intensity.  Counterintuitively, a study found ST to love salt-- and perhaps it is because it changes the taste sensation of foods to which it is added.  If American, they're unlikely to love exotic cuisines, because the chances of avoiding a bitter vegetable or component in a sauce is small.  Other STs are actually SSs:  super smellers.  Since about 80% of taste is actually interpretation and response to odor, these people are also getting three-ring circuses when you are getting the one clown with the big flower.  It's just too much information.

fungi are not everyone's cup of tea

There are other reasons for food aversions.  For many, it's the textures that get them, and these people may also have more complicated responses to clothing (can't stand tags, elastic, certain materials) and touch.  Swallowing disorders and certain genetic conditions make up most of the rest of the picky eaters, though I would argue that the latter (including persons with Asperger's, autism, and Tourette's) are likely having sensory issues as the root problem.

It may seem like a small deal, but food aversion issues can be pretty problematic.  There are social consequences, from teasing to relationship/marital conflict.  It can be hard on self-esteem.  I have worked with clients who years later have issues with eating related to punishments they received for not finishing the food on their plate-- being served the same cold vegetable only for every meal until it was eaten, for example.  Such misplaced "cures" can turn picky eating into full blown eating disorders that last a lifetime.

The Foods That Scare Us

Like many individual differences, picky eating is usually no more a choice than eye color.  Understanding this can be a boon for those of you that love someone who won't eat what you serve.  Instead of arguing, let them choose (and perhaps prepare) their own meal.  If they are a child, limit the choices to healthy ones that are nutrient dense and consider use of supplements. If they are an adult and you are worried about their health, avoid criticism and empathize the concern.  Ask them to reassure you they are getting adequate nutrition.  Encourage them to see a dietician to find out how to protect their body while they are trying to appease their palate.  But don't take it personally.  We often feel that reality is what is true for us, and variations from that are resistance to it.  But each of us pops into the world with very individualized tastes.  Learn to savor the differences.

The Less Nosy Life: Further Notes on Anosmia

Mountian nose-gay.  I cannot confirm or deny its gaying effects, 

   Just finishing a tasteless fresh egg/sharp cheddar sandwich.  It's a little late for dinner, but I realized at bedtime I'd forgotten to eat it.  When nothing tastes like much, it's way easier to do.

I noticed today that I was doing a lot of acceptance talk in the office.  It's not really that unusual that what healers are addressing in their own lives creeps into their work.  Luckily we are talking universal themes here, so no harm done.  But I do want to pay attention when it happens.  That's part of the code of the field, to make sure we aren't just working out our own stuff instead of focusing on our clients'.  So I spent some intentional time thinking about how resistant I have been to this adventure in smell-less-ness.

Social worker and author Thom Rutledge sums it up nicely:  the mathematical formula for pain is the difference between our expectations and our performances.  If you substitute experiences/reality for performance, the equation is equally profound.  As teacher Byron Katie puts it, "When I resist reality, I suffer, but only 100% of the time."

The Buddhists refer to this discomfort of resisting experience as three poisons, aka causes of human suffering:  greed, anger, and ignorance.  When I want what I cannot have, rail against the God/gods because of it, and don't understand the nature of reality, I suffer.  Ruttledge, or was it  DBT theorist Marsha Linehan, or maybe Buddha (there is truly nothing new under the sun) said that pain is inevitable.  But suffering, which occurs out of resistance, is optional. 

Resistance equals grasping. When we try to hold on to what is not there, or attain what is unnatural, or maintain what is transient, we are grasping.  And it causes suffering.

But when we have a loss, it is human nature to grieve.  Whether it's a missed goal, a death, a function-- we are here in these human bodies with these human minds and egos, and it is natural and fitting to give notice and due to what has gone.  And then, sooner or later, we make a choice.  We can continue fretting about what isn't, or we can move forward with this present reality of what is.  When we start that--- when we move a little out of ignorance and anger and greed for what we want but can't or don't have-- we can start integrating an experience and seeing what is valuable and what merely must be tolerated/accepted.

I'd like to claim I do this at least occasionally with grace and dignity.  But truth be told, I often enter into unpleasant realities with kicking and moaning and resistance. 

Last night walking'  I passed a neighbor just as she was sniffing a rose she'd cut.  Immediately tears came into my eyes.  I was a little embarrassed when she met my gaze, but also able to be a compassionate witness to what was true for me in that moment.  I know that anosmia is not a big tragedy on big life terms, so I have gone back and forth about expressing it as an important loss.  But I feel it, and feelings-- well, they are what they are.

What's been sweet:  I've gotten some notes from folks who've read this blog, expressing understanding for what has felt true.  We need witnesses.  It helps to have somebody confirm our experience.  Here are some excepts:

."It feels insufficient to say I am sorry, but I am ..sorry that your olfactory life is on a hopefully brief hiatus.  I imagine your sense of smell is in a safe place, tucked away and protected for its eventual return to you."

"I'm sorry. This isn't whining or trivial in the least.  You talk and think about how things smell more than anyone I've every met.  You must feel a great sense of loss."

"Wow...I'm so sorry to hear about your olfactory tragedy.  I'm going to choose that it will come back."

OK, me too.  But if not, I hope to use it for some sort of growth.  I am currently focusing on increasing mindfulness and appreciation to textures and nutrient value of food rather than flavor.  I've long claimed big interest in the latter, but in a sort of martyr-y way unless it tasted fabulous.  I tolerated for the cause rather than appreciated things like raw radishes and kale.  But since not much tastes much at all, when it's healthy there's more sense of reward in eating it.  And some foods that were ho-hum to me (wheat berries!) have become much more interesting to my newly 2-D palate based solely on texture.

Other perks:  I no longer cringe when someone wears perfume/fragrant cosmetics or cleansing products.  Remember, I was a super-smeller, so what was appealing to others was very infringing to me.  I can concentrate a little better in restaurants and outdoors, because one source of constant stimulation is now quiet.  I am hoping this will take my pinball-like mind down a notch of activity.

Speaking of pinball, I decided to celebrate a deliberate move to more light-heartedness with an evening of same at our local Life-Long Learning Establishment, Squirrels.  I found two willing companions who agreed to let me beat the pants off them (ok, at least the first several games, and yes, J & L, I am still being cheeky about that).  When I was a kid visiting my aunt in Pawnee Rock KS (population 300-odd, depending on if there was something interesting happening down the road), she'd give me rolls of nickles to keep me out of her hair while she ran the county's sole tavern/restaurant.  It would be pitiful to say those were glory years, but I was indeed a wizard for a while.  Being much too schooled in the psychological I am well aware my desire to go beat up a machine was a regressive move to a simpler time, but it's less ridiculous and permanent than getting something extra pierced at my age.  With full acceptance entering my intent, I had a ridiculously delightful time, and my heart lost about 6 pounds of pouty puffiness in the process.

Here's to more fun, and since it's at least the current reality, less smells.  I'm going to stop railing a against it (poisonous anger) and get into it a while (decreasing ignorance and letting go of graspy greed) and just be a curious observer for what's new in this different world I've plunked down into.

Today's assignment:  when life gives you lemons, build a dopamine model using licorice sticks for bonds, and call it Good Art.  Or at least have a blast in the process.

I think I'll stick with the sensory deal for a while.  Coming up-- SUPERTASTERS EXPOSED:  Excellent Artists and Poets, Annoying Dinner Companions ---Especially if you're cooking..

Ill be smelling you in all the old familiar places (or at least imaging)...
Jana

Song of the day, a paean to times gone by (with buried reference as to why I'm not quite on my game).

The Less Nosy Life: Further Notes on Asnosmia

Just finishing a pretty tasteless fresh egg/sharp cheddar sandwich.  It's a little late for dinner, but I realized around 9 I had forgotten to eat it.  Those of you that know me--or at least have seen me in the last decade or two-- know I seldom miss a meal.  But when nothing tastes like much, it's way easier to do.

I noticed today that I was doing a lot of acceptance talk in the office.  It's not really that unusual that what healers are addressing in their own lives creeps into the office.  Luckily, we are talking universal themes here, so no problem, but I do want to pay attention.  That's part of the code of the field, to make sure we aren't just working out our own stuff instead of paying attention to our clients'.  So I spent some time thinking about how resistant I have been to this adventure.

Thom Ruttledge, a social worker who I believe I've quoted on these pages before, sums it up nicely.  The mathmatical formula for pain is the difference between our expectations and our performances.  I don't know if he says this part, but I substitute experiences/reality for performance, and the equation is equally profound.  As Byron Katie puts it, "When I resist reality, I suffer, but only 100% of the time."

The Buddhists refer to this discomfort of resisting experience as three poisons, aka causes of human suffering:  greed, anger, and ignorance.  When I want what I cannot have, rail against the God/gods because of it, and don't understand the nature of reality, I suffer.  Rutledge, or maybe it was DBT theorist Marsha Linehan, or maybe it was Buddha (there is truly nothing new under the sun) said that pain is inevitable; suffering, which occurs out of resistance, is optional. 

Resistance equals grasping. When we try to hold on to what is not there, or attain what is unnatural, or maintain what is transient, we are grasping.  And it causes suffering.

But when we have a loss, it is human nature to grieve.  Whether it's a missed goal, a death, a function-- we are here in these human bodies with these human minds and egos, and it is natural and fitting to give notice and due.  And then, sooner or later, we make a choice.  We can continue fretting about what isn't, or we can move forward with this present reality of what is.  When we start that--- when we move a little out of ignorance and anger and greed for what we want but can't or don't have-- we can start integrating an experience and seeing what is valuable and what merely must be tolerated/accepted.

I'd like to claim I do this at least occasionally with grace and dignity.  But truth be told, I often enter into unpleasant realities with some kicking and moaning and lots of resistance. 

Last night, walking to meet a friend, I passed a neighbor just as she was sniffing a rose she'd cut.  Immediately tears came into my eyes.  I was a little embarrassed when she met my gaze, but also able to be a compassionate witness to what was true for me in that moment.  I know this is not a big tragedy on big life terms, so I have gone back and forth about expressing this as a profound loss.  But I felt it, and feelings-- well, they are what they are.

What's been sweet:  I've gotten some notes from folks who've read this blog, expressing understanding for what has felt true.  We need witnesses.  It helps to have somebody confirm our experience.  Here are some excepts:

."It feels insufficient to say i am sorry, but i am ..sorry that your olfactory life is on a hopefully brief hiatus.  i imagine your sense of smell is in a safe place, tucked away and protected for its eventual return to you."

"I'm sorry. This isn't whining or trivial in the least.  You talk and think about how things smell more than anyone I've every met.  You must feel a great sense of loss."

"Wow...I'm so sorry to hear about your olfactory tragedy.  I'm going to choose that it will come back."

OK, me too.  But if not, I hope to use it for some sort of growth.  I am currently focusing on increasing mindfulness and appreciation to textures and nutrient value of food rather than flavor.  Truth be told, I have always claimed big interest in the latter, but in a sort of martyr-y way unless it tasted fabulous.  I tolerated for the cause rather than appreciated.  But since not much tastes much at all, when it's healthy it's rewarding in a bigger way to eat.  And some foods that were ho-hum to me (wheat berries!) have become much more interesting because of the sensation of texture they bring to the 2-D palate.

Other perks:  I no longer cringe when someone wears perfume/fragrant cosmetics or cleansing products.  Remember, I was a super-smeller, so what was appealing to others was very infringing to me.  I can concentrate a little better in restaurants and outdoors, because one source of constant stimulation is now quiet.  I am hoping this will take my pinball-like mind down a notch of activity.

Speaking of pinball, I decided to celebrate a deliberate move to more light-heartedness with an evening of same at our local Life-Long Learning Establishment, Squirrels.  I found two willing companions who agreed to let me beat the pants off them (ok, at least the first several games, and yes, J & L, I am still being cheeky about that).  When I was a kid visiting my aunt in Pawnee Rock KS (population 300-odd, depending on if there was something interesting happening down the road), she'd give me rolls of nickles to keep me out of her hair while she ran the county's sole tavern/restaraunt.  It would be pitiful to say those were glory years, but I was indeed a wizard for a while.  Being much too schooled in the psychological I am well aware my desire to go beat up a machine was a regressive move to a simpler time, but it's less ridiculous and permanent than getting something extra pierced at my age.  With full acceptance entering my intent, I had a ridiculously delightful time, and my heart lost about 6 pounds of pouty puffiness in the process.

Here's to more fun, and since it's at least the current reality, less smells.  I'm going to stop railing a against it (poisonous anger) and get into it a while (decreasing ignorance and letting go of graspy greed) and just be a curious observer for what's new in this different world I've plunked down into.

Today's assignment:  when life gives you lemons, build a dopamine model using licorice sticks for bonds, and call it Good Art.  Or at least have a blast in the process.

I think I'll stick with the sensory deal for a while.  Coming up-- SUPERTASTERS EXPOSED:  Excellent Artists and Poets, Annoying Dinner Companions ---Especially if you're cooking..

Ill be smelling you in all the old familiar places (or at least imaging)...
Jana

A life of non-scents: Anosmia

If asked which of the five senses they felt they could most easily give up,  the average American will say smell without much thought.  

But if you are one of the estimated two million with a smell disorder, you may be thinking differently.

A (naturally) scentless sedum blooms on Iron Mountain

Goodbye to All That

Anosmia is the scientific name for loss of smell (dysosmia refers to the distortion of smell and is no big ball of fun either).  It may not seem like a big deal.  We take olfaction for granted.  But the sense of smell is interwoven in the most minute and profound details of our lives.  Memory, mate selection, pleasure, nutrition, safety:  the nose knows and informs all of it.

There are lots of ways to lose your sense of smell.  Aging is up there, and it's common for people after 60 to have a decline in ability to differentiate odors.  The decline is gradual, and may not even be fully perceived.  A sudden loss of smell indicates something more troublesome.  A good bonk on the head (frontal head injuries) can result in permanent loss of smell as connections between the nose and brain are sheared. The prognosis for recovery from this type of anosmia is not great. Medication can be a factor.  There have been lawsuits and FDA warnings against a popular nasal spray implicated in anosmia.  Some medications will temporarily alter the sense of taste and smell, but it's possible that the infections that induced the use of these medications caused the injury.  Sinus infections can cause temporary and rarely, permanent loss of smell.  And acute viral infections may result in either, when the virus attacks and kills off cells responsible for interpreting the olfactory world.

When the nose becomes just an appendage for holding up those Raybans, the effects are myriad.

The Scent of Yesterday

"When nothing else subsists from the past, after the people are dead, after the things are broken and scattered· the smell and taste of things remain poised a long time, like souls· bearing resiliently, on tiny and almost impalpable drops of their essence, the immense edifice of memory."
                                     -Marcel Proust, The Remembrance of Things Past

Catching a whiff of red cedar, I immediately "see" my grandfather on his porch in Tennessee, whittling branches he'd cut from the aromatic tree.  The scent of lilacs bring to mind my mother in her garden, and roses my 7th grade piano teacher (she wore an Avon brand rose perfume).  Patchouli recalls Oregon County Fair, high school, Eugene Market.  The smoky saddle-leather smell of Lapsang Souchong tea takes me back to long philosophical talks with an early mentor.


Smell is a powerful link to memory.  From an evolutionary perspective, that makes perfect sense. Olfactory activity is directly linked to that brainy seat of emotion, the hippocampus, which mediates learning and memory.  Other senses make a more indirect meander to storage, and thus retrieval, of what has been important to our history.  But with smell-- we know right away what we are drawn to, and what we really, really want to avoid.

Something Stinks

kelp guy smelled:  not good

Cesspools, rotting food, festering wounds, dead animals and people:  it takes a lot of exposure to get over our instinctual revulsion to "bad" smells.  Again, natural instinct serves us well, and we want to get the heck away from what stinks.  Our nose is located front and center on our face, in between our eyes and mouths, for a reason-- to keep that bad stuff out of our bodies.  Sickness has a scent, and we don't like it.  Visit a hospital or hospice, and underneath the disinfectant, you can smell it.   The smell of decay, whether of food or living beings, has a "get away" force on us, and it's much more physical than psychological.  Since odor is processed directly through the hippocampus, brain urges straight to flight mode-- sometimes stopping to vomit, in case we have ingested anything that might send us to a similar state.

People with anosmia face safety issues when deprived of this primary warning system.  If you don't smell the smoke, you may lose precious time to escape the fire.  If you can't smell rot, you may eat food that's turned the corner from life-giving to deadly.  You don't smell the odorants in gas, the mold in the shower. These are the more alarming aspects to living with anosmia.

Scents and Edibility

beet tart, Gathering Together Farm

But it’s not just the bad stuff the nose makes important.  Olfaction is intimately involved in eating.  Odors don't just notify us of spoilage, they comprise the majority of what we come to know as taste.  Without scent, our palate is limited to identifying only the hint of the most rudimentary flavors: salty, bitter, sour, sweet and umami (savory).  If you've recently had a cold, you may remember that food just wasn't that interesting.  That's because most of what we call taste is really our brain processing odors.  Blindfolded and with your nose pinched shut, you won't taste the difference between a carrot and an apple.  People with sudden onset anosmia often lose interest in food, because they cannot taste it.  It's all various stages of cardboard:  gluey, pulpy, crunchy, chewy but in the end tasteless.  An exception is fiery foods, such as chilies, which at least provide a physical sensation in the mouth as they trigger the trigeminal nerve.

You May Sniff The Bride

Smell is involved in much more than alerting us to danger, retrieving memories, or helping us differentiate and enjoy tastes.  From the time we are born we begin processing and storing olfactory information.  Babies hardwire early on to their mother's scent, and lovers often fixate on the smells of their partner.  Our sense of smell actually helps us chose an appropriate partner with whom to procreate: studies have found that people prefer the scent of those less genetically related.  Because a disparity of genes means less gene-linked disease, such partnerships result in more viable offspring.

But science is a poor poet, and lovers simply say "you smell like home."

A Less Dimensional World

Until lately I never thought twice about the scentless world.  But three months ago I checked out a book by garden writer Bonnie Blodgett about her experience with sudden anosmia.  In her case, it started with phantom smells.  Her nose was trying to make up for all the sensation she wasn't receiving, and she was tortured by olfactory hallucinations of the stinkiest sort. It was fascinating reading, but I didn't finish it before the two-week library loan was up (I'm the reading equivalent of a channel surfer, and had five other books out).  Meanwhile, local author Keith Scribner’s latest novel was released.  I probably would have bought it anyway, but it helped that Keith had been holing up the last three years in an office 20 feet from mine while he wrote it.  I was curious to see the results.  The novel opens with a literally sensual drive through into Willamette valley, and the protagonist's wife, a "professional nose" (fragrance specialist) who’d gone asomniac catches fresh mint scenting the night air—her first clue that she may be regaining her grieved sense.

All of this was trivial synchronicity until June.

Of the five senses, smell has always been my home-run best.  I was born a super-smeller, one of those people who knows what you ate for breakfast if I visit you at dinner.  Ask my dear friend and walking partner Lisa.  Many of our late night strolls have been punctuated with my running aromatic narratives:  "Sewer's backing up!"  "I smell dryer sheets".  "Ah, jasmine blooming!"  There was definitely a down side.  Moldy oranges, Axe bodywash, cat piss-- I couldn’t help attending to it, blocks away.  But the upside? A summer day on Mary's Peak had me rhapsodic: chamomile and fir on the breeze.  And while I may lack fancy-ass oenophile terms, I could really enjoy a glass of wine; could taste everything from concrete to kiwi in a sip of stainless barreled Riesling.  I'm a bit of a synesthesiac, and smell and taste were a multi-layered sensory pleasure.  Fragrances had heft and texture, from velvet to burlap to silk.

sniffing the subway

All that disappeared in June.  I came down with a kick-your-ass virus, the first I've had in years.  I ran a fever, went through a couple of boxes of tissue, took to my bed, took sick leave from my private practice for the first time I can remember.  It was grass season in the valley, a time when I get pretty stuffy anyway, so it was a week or two of feeling better before I realized that even though I felt fine, something pretty radical was going on.

I could smell absolutely nothing.  Not rubbing alcohol, not the cat's litterbox,  not a campfire.  And taste very, very little.  Making pesto with fresh basil from my CSA box, I toasted $20/lb pine nuts and ground the basil with young garlic:  nothing.  Went to Country Fair in early July, and for the first time didn't notice the marijuana, the patchouli, the food booths, the 10,000 unwashed and very sweaty humans.  A bonus gift?  Walking past the Peacock outdoor smoking lounge to get to Magenta's-- no problem.  Of course, when I got there and ordered my pricey ginger martini, I might have been better off sticking to the water.  If it hadn't been for those floating fleshy bits and yuppie bar tab, I'd have been hard-pressed to notice the difference.

At first I thought it would clear in a week or two.  Two months later, I'm not so sure.  Sparky The Head Doc, (aka "Dr. Babe-to-you"), my neurologist sister, is pretty sure the goose-egg I grew after trying to relocate an old growth cedar branch with my forehead could also be involved in my troubles. It happened around the same time I was sick.  (Warning:  don’t garden in big hats if you are going to get lost in your fevery thoughts).

My son made a rich bread pudding tonight, which my usually taciturn sweetheart pronounced "incredible”.  For me, it was like eating school paste, and I gave it up after a bite. The fresh fruit salad with mint from the garden had guests exclaiming they’d smelled it from the driveway, but I couldn't identify a single component by taste.  Not even the raspberries I’d picked fresh and melting with juice only hours earlier.

Beginnings of the Bad Gooseberry Pie

I have taken to declining offers to dine out.  Why pay for food that gives no pleasure? And anosmia has certainly not improved my cooking.  I made a fresh gooseberry pie several weeks ago, so sour and salty it was barely edible-- but I couldn't taste it to know.  I still reflexively eat.  Sometimes I don't finish it, disappointed.  Sometimes I overeat, trying to find something that pleases--chasing an elusive gustatory high.

 I went to my doctor, pretty much figuring what I already knew, that there was nothing to be done.  But I wanted to do something.  She ran a few tests, then acknowledged either it would come back, or it wouldn't.  Meanwhile I am trying to get into textures instead of tastes with food, and the occasional sensation. But frankly I am pretty down about the whole thing.  It's as if a third of my world has vanished.  I suppose in the scheme of things it's a small tragedy, but it's a whole lot bigger than I would have imagined.

Earlier this evening I thought I caught a whiff of that bread pudding baking.  A slight hint of the butter, or cinnamon.  It made me hopeful.  I was really, really sad when I tasted it later-- or rather, didn't.

If my sense of smell doesn't return, I suppose I will learn to compensate.  I'll remember to check the burner instead of waiting for my son to run up from the basement to tell me the house is filling with gas.  I'll get more into colors and textures with food.  I'll give up cooking, or at least try to follow recipes rather than making it up as I go along.  Maybe now that I can't be a foodie, I'll lose a few pounds.

But I hope those memories-- the ones profoundly linked to scent-- will remain.  I worry about that.

Further reading:
Remembering Smell:  A Memoir of Losing--and Discovering--the Primal Sense, by Bonnie Blodgett
The Nose That Never Knows:  The Miseries of Losing the Sense of Smell, Elizabeth Zierah, Slate.Com
Smell and Memory, by the awesome Jonah Lehrer
Failing the Sniff Test:  The Nose, Ruined.  Paul Lucas, New York Times 2005. 
Yahoo Anosmia Support Group:  help and information from fellow sniff failers.
The Oregon Experiment, a novel by Keith Scribner