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The spirit of the season.

I came back from my Christmas gathering on the second day of Christmas, collapsed into bed, and slept for about two and a half hours. And then I woke up, and I felt much, much better. Until it was time for the next one.

 

I was grateful during the last couple of weeks of Advent to come upon a couple of pieces of writing that acknowledged the dark side of Christmas.

Anne Kennedy at Preventing Grace taps the nail in, just far enough, with a precise little hammer:

The trouble is, the world demands untempered joy. It’s Christmas. Get it together. So what if you lost someone last week, or your marriage just ended, or your child was diagnosed with something hideous, or you just don’t have the emotional furniture required to deal with all the extra work and demands of the season. Turn that frown upside down and tuck all that trouble away.

...This is why it’s so important not to conflate the church’s celebration with the world’s. The world has its own measures of success and happiness, its own ways of rejoicing, and they usually involve you showing to everyone else who much you have it together and the beauty of your life overall. And you showing yourself that.

Whereas the church’s celebration is about God overcoming the darkness of our human condition. These are two very different kinds of joy. The one floats on clouds of tinsel. The other passes through the valley of the shadow of death.

Kate Cousino at The Personalist Project puts an optimistic spin on Christmas pessimism:

We often have occasion to remember that no joy in this life comes to us entirely unmixed with sorrow. The wheat and the tares grow together until the harvest, and the poor we will have always. It's clear that an earthly, here-and-now paradise is not promised to us...

...God became man and came to live among us, not despite our sins and the darkness and hardness of our hearts, but—o happy fault!—because of them, in response to them...

..."There is a crack, a crack in everything/That's how the light gets in."

+ + +

I didn't even have the emotional furniture, as Anne put it, to write the post before Christmas, when I might have been a useful witness to other people in the same situation, but I will do it now anyway.

Christmas is when I feel most cut off from the universal Church, and when I feel most deprived of grace and strength.

Mark asked me a few weeks ago, when I was starting to despair about the rapid approach of Advent, what he could do to make Christmas easier for me, and I immediately answered, "To stay here in our own home, and not give or receive any presents, except some things for the kids."

And then I followed that up with "I know we can't do that, and I know it doesn't make any sense." Because it doesn't make any sense. It is entirely irrational. It comes from nothing and it ends in nothing. And I know that it will not actually make me feel better, in the long run, to give in -- for Christmas -- to my own Christmas anxiety.

For one thing, like fear of flying, like fear of open spaces, it's probably better not to give an inch lest it take a mile: better to confront it every year and push it back as hard as I can.

For another thing, I am entirely aware that the problem is inside my own heart and mind and soul. I have already pared away as much excess as I can, and done my best to surround myself with people who are kind and joyful. I am aware that I have the power to put one foot in front of another for twelve days (or whatever) and I am aware that many of the anxious negative messages my brain feels like bringing to my attention are illusions. I remind myself of that every day, and it doesn't make the feelings go away, but it helps me keep moving.

For another thing, I don't want my husband's Christmas, my children's Christmas, to be ruled by my own interior and temporary (if yearly) insanity. They are normal people who appear to love Christmastime, presents, gatherings, feasts. They can have a good Christmas and I should get out of the way and let them. I just hope they can do it without a great deal of support from me.

+ + +

Let me go back to just one aspect: feeling cut off from the Church.

I have been anxious and exhausted at Christmas for as long as I can remember. Last year, I wrote a relatively frank post about that.

I was in college before I really found out that Christmas had an other side, and just as I was discovering it, in darkness and unfamiliar music, lit by purple candles, I had to go back to the house(s) I grew up in for the holidays. I stalked out into the night on Christmas Eve, took the car, and would not say where I was going.

I went, but I wasn't yet allowed to participate. And Christmas still feels like that to me. I am looking in through the glass.

+ + +

I almost get there, and every year, mid-Advent, I lose my grip on it.

Part of it is location. I am homesick. Every year we leave town, leave our lovely parish where my sons serve and my daughter sings in the choir, and I find myself at Christmas Day mass at a strange parish with unfamiliar music set to unfamiliar drums. After communion I squeeze my eyes shut and pray fervently for mercy on my judgmental and elitist heart, so that I can't see the usher dressed as a Coca-Cola Santa Claus come in and kneel down and give a present to the Baby Jesus before the accompaniment music is over. Because if I watch it, I am going to roll my eyes and embarrass my teenage sons.

And part of it is my own reaction to the location. At the same time that I am trying not to roll my eyes I am trying to stop thinking mean thoughts about the Santa suit because it just goes to show what a terrible Christian I am at the time of the year when everyone else is much better at it than usual. I try to think, in measured tones in my head, "I am surrounded by people who love Jesus and care for each other. Jesus is here in the tabernacle. It is all the same." But my heart is two sizes too small and can't make the leap. This is, I know, a stupid, ridiculous cross. All of my crosses are completely stupid and worthless. The things that get between me and Jesus are so very stupid and transparent and superficial dumb and even I can see how dumb they are.

And part of it is that it lasts so long. Exhausted by people -- all people. I find myself, at the holidays, making my way through crowds of relatives -- they aren't even my own relatives, and they are actually wonderful human beings -- but making my way through feels like swimming on days when it's really tough and I have no energy -- there are days when I get to the pool and it feels like swimming in syrup. And making my way through the relatives can feel like that. It is not any one individual, it's just that it is so relentless. Three days, maybe more, and a party every day.

After a while when I have to be at a party every day my mind plays tricks on me. I start to get impostor syndrome, like in graduate school, only instead of having faked my way into being a research engineer I feel like I have faked my membership in the human race. Everyone is just playing along to avoid embarrassing me. This year was worse than most, and I retreated into the corner with my wine and looked stuff up on my phone.

+ + +

Why so bad this year? Mark has a theory that it's because a lot of things were up in the air. My grandmother is having more health problems, and we weren't sure what Christmas would look like, what schedule I could keep. Mark said: "I think it is hard for you to have to operate without a fixed plan. You like to have it all figured out ahead of time, because you are afraid that otherwise you'll have to wing it and that you'll be blamed if something goes poorly."

I think he is probably right about that.

But at the same time I could feel glad that I had pared some of the stressors away. I tried buying fewer presents this year, especially for people whom I didn't know well enough to actually shop thoughtfully for, and do you know what happened?

Nothing. No one complained.

Instead of visiting absolutely everyone I felt an obligation to go see in my few days in town, I tried going to see the people I wanted to see, and instead of visiting the others, sending flowers and a card. I hope you have a merry Christmas, I wrote. I didn't mention visiting. And do you know what happened?

Nothing. No one complained. When I stopped offering my time to those folks, no one even asked why I didn't come.

I felt relief.

+ + +

Despite what progress I have made, I go on feeling pretty insane at Christmas, even though I guess I am not insane enough to deserve the title. Two mental health professionals have confirmed me to be insufficiently off-kilter to merit a diagnosis of any kind in the off-season, and apparently there is nothing in the DSM about an anxiety or depression that only lasts six predictable weeks every year.

So the good news is that it might be all in my head.

But I feel it in my body. I feel it like fear or like grief, a round hard thing in my chest, the heart two sizes too small, perhaps, or a lump of poorly digested shortbread cookies. Like tension in my shoulders, low-grade nausea, sleepiness. I know it is irrational but I can't make it go away by thinking the right thoughts about it. Just pick it up and carry it into next year, and in a week or two it will be as if I never left.

But for now: I pour out my weakness to the Mother of Sorrows. I try to embrace the terrible coda to the Annunciation, the words of Simeon and Anna. Christmas has a dark side, and maybe it could be okay that I live there, in the terrible stillness, if only I felt I could get away with it.

 

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Tween-related maternal depression: what about family size?

Time for a short mental-health blog post while I work on a different, longer one behind the scenes.

This article at NPR is going around on Facebook today: "Being Mom to a Middle Schooler Can Be The Toughest Gig of All:"

Many women assume that the first year of motherhood is the most precarious time for their mental health. But a recent study published in Developmental Psychology finds that maternal depression is actually most common among mothers of middle school children as they catapult into the tween years.

...[The study authors] discovered that the years surrounding the onset of adolescence are among the most difficult times for mothers. During this period of transition, women can feel lonely, empty and dissatisfied with their mothering roles. The researchers also found that compared to mothers of infants, these women experience the lowest levels of maternal happiness and are even more stressed out than new parents.

Luthar says that tweener moms reported feeling the most unhappy or depressed when their children are in middle school, but that the transition begins when children are 10 years old. Parents of teens are actually happier than parents of middle schoolers.

Two of my five children have already passed from tween years into teen years, and my third is entering that stage. I am familiar with how tricky it can be to adjust my parenting style towards each individual child in the years between ten and thirteen -- it encompasses a big change in autonomy, skills, and responsibility. They go from being baby-sat to being babysitters; they learn to walk to the store to buy a carton of milk; they learn to cook dinner, to manage their own schoolwork time, to make judgments about the media they consume. There is a lot going on, for sure, and it is not always easy. Sometimes I have despaired of my own competence -- whether I could figure out the right balance between guidance and self-guidance, between rules and freedom, for each young person.

But I was struck by one big difference between my experience and the experiences of the women who were profiled in the article:

I have never been totally immersed in my own feelings of incompetence. And that is, I believe, because I never have and never will have all my children going through those years at once.

When my very first child turned ten, I also had a seven-year-old, a four-year-old, and a baby. You might think that this would be tough, and of course I was very busy and frequently overwhelmed by how much there was to do. I had feelings of incompetence. But I wasn't paralyzed by feelings of incompetence (as if I had time for that) -- I believe that's because I got to feel competent at the same time.

Raising a ten-year-old was hard because it was new to me. And I was leery about my seven-year-old turning eight, because I remembered it being difficult to teach an eight-year-old. But at the same time as I was struggling to figure those out, I had the privilege of mothering a four-year-old who was utterly delightful, as all four-year-olds have been in my experience. And I was carrying around on my hip in a wrap sling a beautiful eight-month-old nursling that year, too -- lucky me, because I have always felt at the height of my powers with those nursing babies. Despite having a cerebral and analytical approach to life in general, I always felt able to tap into an intuitive, biological mothering style, towards babies, that has rarely steered me wrong during the first three years of life.

From the article:

Brizendine says that for most women, estrogen and progesterone levels start decreasing after age 42. With estrogen depletion, women may feel less nurturing. As a result, they can feel more agitated with themselves, their partners and their children. Additionally, mothering tweens doesn't offer the hormonal reward — the oxytocin "love rush" — that caring for little children provides.

But see, I am 42, and I am still caring for little children. I always wanted to have a teenager and a baby at the same time, and I got that. I got all the benefits of oxytocin (am still getting it -- my three-year-old nurses a couple of times a day) at the same time as I get to teach physics and set teens up with drivers' ed.

Just as things were only starting to get tricky at the upper end of my family, I was deeply immersed in parenting children during the years when I feel most competent and powerful. At least given that I did not suffer from any clinical depression, I could never have been fooled into thinking I was a bad mother in general, even if I might have wondered if I was any good at this older-kid thing.

I am looking forward to the mirror image of my experience at the end of my childraising years. When my very youngest becomes a tween, I will not have any babies or preschoolers to enjoy at the same time; but I will still have two teenagers in the house and grown-up children to enjoy as well. I will have, I hope, the perspective of having ferried several kids to the other side.

In short, for me -- grown woman that I am -- there are no "years surrounding the onset of adolescence." Each child will have his or her tween years, but I will not have any years that are all-tween, all-the-time. I could be wrong about the causality, but it seems like the broad age-span of my offspring has helped me feel less incompetent, less of a good-mom impostor, at every stage than I might have otherwise.

Smaller families and shorter periods of child-raising have accompanied many changes in living standards that are regarded generally as positive, I know, but there are unlooked-for consequences to all social change. I wonder if the feeling of "I totally don't know what I am doing here" is more widespread than it used to be when four kids wasn't a completely ridiculous number of children to have.

 

 

 

An algorithm for co-schooling in the face of norovirus.

H and I have been getting together twice a week for years now, sometimes with a third family, for co-schooling. We have always tried to minimize the number of skipped days, so that the kids' education doesn't get too interrupted and so we can keep a steady routine; and that's felt more important as children have grown into high school students.

A long time ago, we made up our minds that there was no point in skipping school days together because of rhinovirus symptoms. Colds last a long time, and when you only go three days without seeing one another, chances are good we already passed it on. We also don't typically skip school for conjunctivitis, head lice, or strep (once the antibiotics have started).

We do typically skip school if someone has been vomiting recently. Nobody wants to pass that along! But we had always lacked an algorithm for deciding when to resume getting together after symptoms have disappeared.

Part of that has been that our families have different attitudes about GI illness. This is in turn because we tend to experience GI illness differently.

H and her kids always seem to be hit very hard by any stomach bug, a couple of times every winter. The children need to be rehydrated a teaspoon at a time and can't keep anything down for days, everyone is miserable, and her older kids are petrified of catching the bug. So in H's family, as soon as someone shows sign of illness, H and her older kids go into high-alert transmission prevention:

• Well people isolate themselves to a different floor of the house with its own bathroom
• The ill person uses only one bathroom
• No well people except H cares for sick people, unless she is too sick to do it herself
• Ill people and the person caring for them don't cook or prepare food
• Everything is laundered with bleach on the sanitize cycle
• Dishes are washed on the sanitize cycle
• Surfaces are disinfected as soon after vomiting as is practical using a wet bleach solution left to sit 5-15 minutes
• Until the twin toddlers are recovered, they stay on the main level of the house only
• H sleeps with the twin toddlers on a blanket on the wood floor so all sleep surfaces are bleachable or washable in the machine
• H personally supervises all toddler vomiting, toileting and handwashing
• Young recently-potty-trained children must wear diapers
• Vomit basins are disinfected with bleach between episodes
• Hard toys that children had while sick are disinfected with bleach

In other words, it's really important to H and her kids that they try as hard as they possibly can to avoid passing the bug to each other.

Whereas, in my family, my kids tend to throw up a couple of times and sleep a bit more, and then feel pretty good in between vomitings. And I know that you have to work hard to avoid transmitting, say, a norovirus in close quarters. So my attitude has tended to be more like, "We are all doomed anyway; let's just get this over quickly."  I tend to put the sick kid on a couch with an iPad and a bucket and go about my business, but with extra handwashing and a supply of saltines, applesauce, and Gatorade on hand.

I suspect that over the years this difference in attitude has caused H to regard me, privately, as astonishingly lax; and me to regard H, privately, as bordering on obsessive. (She'd be the first to tell you that the obsession originates not in her but in her older kids, who voluntarily isolate themselves and compulsively wash their hands until the danger appears to be past.)

+ + +

One thing that's guaranteed to happen every time:  a phone conversation between me and H where we wonder, "Is it safe for us to get together or should we skip another school day?"

We recently passed an apparent norovirus around between our families, and got to talking about developing an algorithm for figuring out how long we should wait, after someone has GI symptoms and then they resolve, before getting together again.  The problem is, we had a lot of unanswered questions.

We do want to avoid passing the bug to people who are still well, but what is a reasonable time to wait?  We knew that people can pass noro to each other for weeks, and it truly isn't feasible to skip our school days together for more than a few weeks -- especially when the risk of transmission drops fairly low. Also, is it even possible to prevent transmission? Maybe waiting an extra half-week will make a difference, but on the other hand maybe we would have been doomed anyway. And given that we get together every 3 or 4 days, has everyone in one family already been exposed before one kid starts throwing up in the middle of the night? And given our asymmetric attitudes toward illness, should we have an asymmetric algorithm for infection prevention? We were not sure.

Fortunately, this blog has its own epidemiologist on retainer: commenter ChristyP, also known as my friend from high school and college, also known as Prof. Christy Porucznik of the Department of Family and Preventive Medicine at the medical school at the University of Utah. 

I sent Christy an email with the subject line "Practical Epidemiology Question!" and included data about our get-together schedule. She replied (the following has been lightly edited, and two emails have been combined, for blog-reading clarity):

Contagious period (= time of viral shedding in stool) for norovirus can be up to 6 weeks (Centers for Disease Control website says 2 weeks or more, my advisor in grad school was doing a trial and it was on the order of 6 weeks in some people).

I'd go for a similar algorithm as used in public schools and daycare centers which is exclusion from school (in your case, attempt to isolate the sick person) for 24 hours after last vomiting.

Incubation period is 24--48 hours (median of 36 hours), and if an exposed household has gone 2 incubation periods without a new case then you are likely home-free. If practical within a household, you might be able to reduce transmission by reserving one bathroom for use of the sick person and try to keep everyone else out of there. In your situation, I wouldn't see a reason to exclude a kid who wasn't ill from co-schooling unless s/he had a massive exposure (nearby when a sibling vomited or participated in cleanup).

In a norovirus situation parents are likely doomed, but also able to practice Excellent Hygiene Behavior. I would even Clorox-wipe your glasses, wash your face and rinse out your mouth in addition to any exposed skin if you were nearby someone vomiting. If you can, you might even employ a vomit shirt (or lab coat) so that you don't inadvertently carry the particles from the room of doom to the rest of the house. The infectious dose is SO LOW. It's on the order of 10 virus particles and they aerosolize! A really intense family hygiene suggestion is to make sure that toothbrushes are in a closed container so that they are not inadvertently contaminated by aerosolized evacuations generated in the same room. Also close the toilet lid. Every time. But that doesn't help with people actively engaged in generating biological aerosols by vomiting.

It is possible that one is shedding virus before the dramatic GI symptoms start, but the time that a person is most contagious is when s/he is experiencing vomiting and/or diarrhea, which is thankfully short. The virus is relatively hardy and can persist on surfaces longer than one might expect (hence long outbreaks on cruise ships and in hotels). Changing towels frequently is probably a good idea....

FWIW, there are several strains of norovirus, and immunity to the strain you most recently had lasts only about 12 weeks.

When I teach Infectious Disease Epidemiology I say that caring for someone with norovirus is the surest way to see your own future. I will also share here one of my favorite bits of advice to share at La Leche League meetings, which is that when your child is still in the vomiting-every-hour phase is when you should prep some snacks that s/he can grab from the fridge the next day, when the child is feeling fine but starving and you are the sick one.

I went back to H and issued my judgment about the correct algorithm, using the more conservative estimate (48h) for the incubation period.

Co-Schooling Gastrointestinal Illness Algorithm

Rule 1:   If anyone gets GI symptoms, skip the next scheduled co-schooling day.

We only go 75 hours between meetings, and it takes 96 hours to find out if the other household has escaped.

 

Rule 2:    When GI symptoms appear in the first family:

• If we last met more than 48 h ago, consider the second family unexposed.
• If we last met less than 48 h ago, consider the second family possibly exposed.
• But if the second family makes it to 96 hours with no symptoms, consider them again to be unexposed.

This rule doesn't bear directly on co-school cancellations, but it does help the second family decide what precautions would be prudent.

 

Rule 3:   If everyone in one family has been sick, we can return to co-schooling after they have all gone 24 hours without symptoms.

Rule 4:   If only some people in one family have been sick, we can return to co-schooling when the sick family has gone 96 hours without symptoms.

This is under the assumption that the not-yet-sick could be incubating the illness and could show symptoms at any time, combined with a strong preference to avoid exposing the unexposed.

 

Rule 5:   If there are some who have been sick and some who have not been sick yet in BOTH families, we can get together after 

• my family has gone without symptoms for 48 hours, and
• H's family has gone without symptoms for 24 hours.

The asymmetry is because H's family is more willing to try to avoid exposing family members; as soon as one person in my house gets sick, I assume we're all going to get it anyway, so I don't care about skipping school to wait out an entire incubation period.  H, however, does think it worthwhile to try.

 

 Rule 6:  If unexposed people are to meet at a house where some have been sick within the past couple of weeks, we must aggressively disinfect surfaces they might reasonably come in contact with.

 This means the kitchen, first-floor bathroom, first-floor light switches and doorknobs and the like; if the very young children haven't all been sick already, then the hard toys too.  Older unexposed people should take responsibility for themselves to practice good handwashing and the like.

 

Rule 7:  When recovered people first meet at an unexposed household, the whole family should shower or bathe before coming and wash hands on arrival.

This sounds like it should go without saying, but it's worth remembering since our younger kids don't ordinarily bathe more often than once a week or so in the winter because of dry skin.

 

+ + +

In addition to the rules for get-togethers, there are two best-practice guidelines, to be followed if practical:

 

Guideline 1:   To limit spreading the virus to public areas in the house, consider isolating sick people to a single bedroom and bathroom upstairs that is not used often by guests.

Because norovirus can persist on surfaces for weeks, the best practice is to keep it off those surfaces in the first place -- especially the ones guests and visitors are likely to use.

 

Guideline 2:  Carefully supervise young children's toileting for 2 to 6 weeks after they have been ill.

They need to be monitored to make sure they wipe, wash hands, put their pants back on, and don't leave used potties lying around.

 

+ + +

It's too late for these rules and guidelines to save us in the current round of noro, but we can keep this in our back pocket for the next time.   

Coming apart at the joints.

I mentioned this past summer that I Did Something To My Hip while running routinely around the lake up here.  It was the first time I'd ever had a running-related injury, and I couldn't stop exclaiming in shock and surprise about how odd it was that something like an easy jog around the lake might, for weeks, send pain shooting down my right leg and up into my back.

At the time I tentatively self-diagnosed the problem as bursitis and decided to treat it with NSAIDs, iliotibial-band stretches, and ice for a while.  I resolved to go see the sports medicine doctor if it didn't get better in about six weeks.  

And it did!  Mostly.  There's still a little bit of irritation there, but I've apparently gotten used to it as it's receded in to the background; I only notice it if I concentrate while I move the joint, and then I'm not sure that I'm not imagining it.  

So I never did go to the sports medicine doctor.

(Why can't I just say "sports doctor?"  It sounds wrong.  But "sports medicine doctor" sounds redundant, although clearly there should also exist sports medicine nurses and the like.  If there is such a thing as "sports medicine" and doctors practice medicine, there should be "sports doctors."   A quick look at Wikipedia has taught me just now that the preferred term is "sports and exercise medicine," abbreviated SEM.  "SEM doctor?"  "Sports and exercise medicine doctor?" "Sports and exercise doctor?"  Whatever.  Mostly Mark and I get around it by calling her Dr. F.)

+ + +

On a Monday three weeks ago I found myself absent-mindedly rubbing my left hand and twisting my rings.  The ring finger felt very slightly sore.  I commented about it to H -- "I wonder if I caught my ring on something" -- but didn't think much more about it until one morning a few days later.

On that day I woke up with my whole left hand stiff and sore -- curling the fingers hurt.  I flexed it experimentally and as I moved each finger I thought I could detect that the pain was in that left ring finger, and the pain in the other fingers was just an accident of the nerves, referred pain.  The pain seemed to get better as I worked the hand, and indeed, an hour after waking up it was completely gone.

The experience repeated the next day and the next, and rather than going away slowly as I'd expect if I had "caught my ring on something," it only seemed to get worse.  But every day the pain was gone after a couple of hours of being up and around.  One night I got up several times in the night with a sick child, instead of sleeping straight through; that morning I didn't have any pain, but it was back again the next morning that I'd been well-rested.

Hmmm.

I moved my rings to the other hand, in case the knuckle swelled up, and started reading and taking notes.

+ + +

If you Google "joint pain in the morning," you get lots of arthritis links.  This seemed to be a premature possibility.  Really?  I'm only 42.  But on the other hand, I have a bilateral family history of psoriasis (father, mother's sister) and also a family history of connective tissue disorders (oldest son).   So.  I called the nurse hotline provided by our insurance company and asked whether to wait and see, go to my primary care provider, who is a family doctor -- family medicine doctor? -- I guess by analogy sports doctor should work -- or go straight to the sports doctor Dr. F.  They sent me to the PCP, so I went.

I got a hand X-ray.   I didn't get to see it because I didn't have time to stick around that long, and instead agreed to be telephoned with results.  The results came back:  nothing visibly wrong with the joint.  No visible inflammation or deterioration.

I guess that's good, although, you know, it still hurts.

So my instructions are to "monitor, ibuprofen if helpful.  If worsening, swelling, catching, locking, other changes, then see sports medicine specialist."

Hey!  "Sports medicine specialist."  

At least the doctor's visit solved that problem.

Now I guess I just wait to see if it gets worse.  

+ + + 

I suppose we are all aging at the rate of one second per second.  I have enjoyed many years relatively free of injuries, for which I am grateful.  Mark has not been so lucky:  he is constantly rehabilitating one thing or another.  He's just gone ahead and made the sports medicine specialist his primary care provider -- did you know you can do that?  A good idea for active individuals whose biggest problem is joint and muscle injury -- and this week he consulted a physical therapist for the first time, and will probably start going in for weekly appointments.  

When you are relatively pain-free and flexible, as many of us are when we are younger, you can interpret most pain as a warning sign and as a signal to stop what you're doing and rest.  But when pain becomes part of your daily life, it no longer makes sense to calculate:  "If I am in pain, that is not a good day to exercise, or to do my daily work."  Provided that the pain is not disabling, it becomes necessary to do the daily things despite the pain, that and the exercise we do to maintain fitness and strength.  For a long time I have been able to say, "I will skip my workout, because part of me is hurting; I'll rest, and get better faster."  But those are the words of someone who is privileged with confidence that there will be a day without pain, quite soon.  

Maybe I am now entering the phase of life where I cannot use a little pain as an excuse to take a day off, because the days without a little pain will not be numerous enough.   I suppose it happens to a lot of people eventually.  I suppose, too, that the more active you are in conjunction with your pain, the more easily you can see which activities seem to help and which activities seem to make it worse, and maybe the quicker you can be to adapt your activities to best manage your strength and flexibility and comfort.

We are planning to go to the climbing gym tonight -- a very finger-strength-centered sort of physical activity! I guess I'll take a page from Mark's book and start today, managing soreness and activity simultaneously, instead of either-or.  And beginning to find out what makes it worse and what makes it better, without being focused on making it go away.

Anxiety and peace.

I have this theory that it is possible, if difficult, for a person who is sick or physically suffering to find mental peace in the midst of it. That it helps anyone to know that suffering isn't total and can't last forever; that it helps a humanist to know that, since everyone suffers, in his suffering he shares in a common humanity that links him to everyone who has lived; that it helps the Christian to believe that suffering has redemptive value and to ask for grace.

I have a little experience with this, but not lots. Mostly when I have been physically ill -- and I have never dealt with misery that was both terrible and indefinite -- I have retreated to bed, resolutely consuming fluids and determinedly resting, planning to be done with it as quickly and responsibly as possible. I have five childbirths to look back on, of course, and in only one of them (number two) do I remember the physical sensations coming at me faster than I felt I could cope; and that one was over before too long. I know that mild discomfort, the kind that is too mild to justify retreating to bed, makes me irritated and whiny, so that I can't help but let everyone around me know that I have an ache; I limp, I wince.

Still I have this theory that one could achieve mental peace in physical suffering of illnesses, the sorts of things that happen to some unlucky people. Gratitude, perspective, transcendence, fellow-feeling, petition, and redemption are all accessible -- in theory -- to people who are physically suffering, alone or in combination. A few sufferers, the lucky from among the unlucky, even report gratitude for the suffering itself, for the lessons it has taught and the graces it has conferred. We can believe those tales without casting aspersions on sufferers who don't manage to find gratitude and peace, I think, since everyone is entitled to tell his own story. So it is possible, and maybe it even is possible to everyone, if we knew how to access it.

Mind you, though, nobody thinks that the inner peace, when it comes, makes the suffering go away.

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So what about mental suffering? Can you find inner peace when you suffer from crippling anxiety? Can you rejoice in clinical depression?

It seems that anxiety, compulsions, depressions, addictions, are illnesses like any other; if they are more mysterious, still they seem to be thorns in the flesh. So just like any other kind of illness, the suffering they create is real in the body. Therefore they ought to be subject to the same "rules" of redemption. They are a way to share in the world's great penance, in the suffering of Christ. They also don't last forever, and connect us to the great mass of humankind stretching back through and beyond history. We can ask for grace to help us bear them.

But it seems a bit of a contradiction in terms to imagine that one can find or be graced with peace in the midst of, say, anxiety. I can imagine being at inner peace in the midst of suffering pain from a pulled muscle or an intestinal illness. I can imagine being at inner peace despite physical limitations from damaged limbs or a weakened immune system. But what can it mean to have found peace at the same time as experiencing the suffering that comes from anxiety? How can peace and anxiety co-exist, be co-experienced in the same consciousness?

I do not have a clinically diagnosed anxiety disorder or compulsion disorder, but I have a compulsive-type personality and I experience subclinical anxiety in certain situations. It is often heightened at the holidays. I was sitting meditatively the other day and contemplating the roil of tension that swirled in my brain, knowing that worry and perfectionism is not the reason for the season, and unsure what the most transcendent and redemptive response to this particular misery might be.

Obviously one asks politely for the grace to cope with one's duties despite the suffering, and one can also ask that it be taken away if that is convenient, please. And I am able to acknowledge that the anxiousness won't last forever, that I will have good days as well as rough ones over the next few weeks, that I will be past the roughest patch eventually, and I won't have to live with it for longer than the rest of my life.

But is the redemptive peace in this sort of suffering found by detaching oneself from it, denying it, forcing oneself up and out of it as much as one can? Or is it found by entering fully into the suffering somehow?

With respect to ordinary, physical pain, it seems that common spiritual advice is never to squelch and deny your sensations, but to embrace the cross so as better to bear up under it. But is embracing a cross of anxiety and depression a way to find peace, or a rejection of it? Does this kind of cross work in the reverse of the physical one? Or is there a way to experience and embrace the cross of anxiety in your body and mind, while experiencing calm and peace in some third area of your consciousness -- your full human person -- at the same time? And what does that feel like, and how would you know when it is happening?

Or do you just have to trust -- based on what you know of what you have done, said, thought in response to your pain -- that it is there, insensible, radiating outward from some center you cannot touch or see?

I don't have answers to this question.

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