BC HEALTH
Saved by @Mollyycolllinss

The events of the week have shaken us all. Murray Bowen described 'societal regression.' Anxiety is contagious in any group and a society is one giant interconnected group, so over time, societies become more and more anxious unless the anxiety is displaced.

1/

 Displacement requires calm, non reactive leadership at every level and we have lacked that at a federal level, hence the massive escalation of anxiety on the 'system' of our society.

2/
Bowen predicted that as we regress we would no longer be able to listen to each other, we'd become highly reactive, continuing the vicious cycle of catching each others' anxiety and reactivity.

We are there.

3/
But we are not doomed. Especially knowing we have a God who cares.

But it requires calm, aware leadership at every level.

4/
Systems theory often measures anxiety and action through the lens of responsibility and control.

I frame it through the notion of spaces

1. The space inside me

2. The space between us

3. The space between me and God.

5/
We often get stuck in an anxiety spiral because we put too much energy into the forth space:

4. The space inside them.

Systems Theory reminds us that spending time and energy on that space is not only futile, it is destructive.

6/
But the first 3 spaces? To coin an old Seinfeld reference, 'That's gold, Jerry. Gold.'

What is mine to carry, what is theirs, what is God's?

7/
Ed Friedman reminds us that working on the nature of our own anxiety, noticing recurring patterns and reactivity in ourselves, is what gives the most potential for change.

8/
The world needs leaders who practice calm presence. Leaders who listen to learn rather than listening to defend or fix. Leaders who can stay connected while strongly disagreeing, who can maintain their own values while connecting to people who violate their values.

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Fortunately we have Jesus of Nazareth as an example of calm, aware presence in the face of hostility and values violations.

10/
So connection and lowering reactivity starts with hyper awareness of the 3 spaces.

1. The Space inside me.

It may sound silly or weird, but maintaining connection with yourself is essential.

11/
A simple example: I have a set of values for my social media behavior because I don't trust myself in the moment as I read people's posts. I get reactive, then I get self righteous, then I fall into the lie, 'one corrective comment from me will help.'

It never does.

12/
I have already established behavior values, so I don't succumb to reactivity. I can live out of my pre chosen values.

That is a simple ex. of being connected to myself. Clarifying my posture, values, behavior BEFORE I get anxious so they can guide me WHEN I am anxious.

13.
The space between me and God is as key because anxiety and reactivity fill that space and infect my awareness of God.

One of the simplest, but most difficult ways to know you are anxious: you forget that God is with you. It is because anxiety has blocked your view.

14/
'We love because He first loved.' All our action is action reaction to The Actor. But anxiety tells me I must initiate, I must act.

I, I, I.

But God invites me into response.

15/
This is no cop out to sit in life's lazy hot tub while God acts. Some of the finest justice advocates I know are the most connected to God. But their activism is a RE-action to the Active God.

16/
So attending to the space inside me, the space between me and God....

Generally, that helps sort out space #2 at the top of this thread and keeps me from falling into the daily temptation to focus on space 4 which is OFF LIMITS!

Peace of Christ be upon you today.

17/17

More from Steve Cuss

Steve Cuss
Steve Cuss
@stevecusswords
I've been doing more study on the constant critic(s) that every church leader deals with. Its amazing how a steady group of 2-5 critics can really tax a leader's health and impact them way beyond their numbers. ie, more than 3 feels like 'legion' to a leader.

1/

All vocations face criticism of course.

I wonder if church criticism is unique because:

a) church leaders tend to conflate personal identity and church health more than most.

b) critics falsely think they know about leading a church because they attend a church.

2/

For example, doctors and teachers face criticism. People come into a Doc with diagnosis from Internet etc. But I wonder if attending and serving in a church makes someone more confident that they know when they really don't know.

3/

I've often marveled, and been hurt by how strongly someone has an opinion about something they've had zero training in. They are oblivious to how broad a church is - they think everyone thinks the same.

4/

One reason they think this is because their phantom mob is usually made up of like minded people. A handful of passionate people agreeing, so they say, 'everyone thinks' but actually it is less than 1% of the church.

5/
LIFE
Steve Cuss
Steve Cuss
@stevecusswords
There are 4 spaces in life, 3 we can do something about. We spend too much time and energy focusing on the one that we cannot and ought not try to manage.

1/

1. Space inside me. What is going on in me? How do I know when I am anxious? We all carry a bubbling collective of pressure, pain, assumptions, inner critic etc that can block our awareness of God and distort reality.

2/

2. Space between people. This can be space between me and you or space between others. Ever walked into a room with people and you felt off? You might be picking up the space between others.

Anxiety is contagious and often the most anxious person has the most power.

3/

3. Space between me and God. It is disturbing how often I forget God With Us.

Chronic anxiety seeps through us like that foam insulation. It finds the nooks and crannies and squeezes out our awareness of God.

But it can be quickly displaced with some tools.

4/

4. The space inside them.

This is the space we spend too much time and energy worrying about. If you've ever thought, 'what were they thinking? Why did they do that, Why wouldn't they _____' you're fixated on the one space you cannot manage.

5/
LIFE
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Steve Cuss
Steve Cuss
@stevecusswords
John says 'perfect love casts out fear.'

Perfect love displaces fear. I think fear can displace our awareness and experience of perfect love. It cannot displace God's love, but it sure can displace our awareness of it.

1/

Knowing you're in anxiety's grip is actually not as easy as we think. We tend to bear down and try harder instead of pausing.

One way to notice it: you are no longer aware of God's presence and God's love.

It could be that your anxiety has displaced your awareness.

2/

Warning Signs:

- you start to think it is all on you/all on your shoulders.
- 'if it is to be, it is up to me.' An anxious statement if ever I heard one.
- An impending feeling of doom or hopelessness.
- Rigid thinking, either-or locked in thinking.
- double binding.

3/

Chronic Anxiety has a 'gospel.'

'it is on you, there is not much you can do, you are not ______ enough, YOU are not enough, there are only bad options, try harder, do more of the same.'

Recognizing Chronic Anxiety's message helps you displace it with the actual Gospel.

4/

Even though we have the Gospel, we often don't access it. We spend most of our time living by our false selves, not by the Gospel. I have been doing this work for decades and I still spend more time living for false self, than I do resting in my identity in Christ.

5/
LIFE
Steve Cuss
Steve Cuss
@stevecusswords
The Inner Critic.

Ugh.

Its hard to dislodge the power and influence the IC has over us. Here is a helpful tool:

1. Find at least one other who cares about you and get together.

1/

2. Have your friend write down the messages your IC tells you as you share it.

3. Then ask her/him to write the adjectives of these messages, ex: 'harsh,' 'unrelenting,' 'condemning.' etc.

So now you have the actual messages on one line and descriptors on the other.

2/

4. Now write the descriptors of God's character and God's posture toward you. Patient, loving, kind etc.

5. What if I were at least as ________ to myself as God is.

3/

We tend to get wigged out by talk of Satan and Spiritual Warfare, but the more I work with people on chronic anxiety, the more convinced I am that our self talk, our IC, the story we tell ourselves about how we MUST be and how the world MUST be is keeping us trapped.

4/

Paul says, 'it is for freedom that Christ has set us free' yet so many are bound by our IC and .the story we tell ourselves.

We give it WAY too much authority, too much real estate in our soul. It has a 'gospel' which is always some form of legalism and condemnation

5/
LIFE
Steve Cuss
Steve Cuss
@stevecusswords
Anxiety resides in 4 spaces:

1. The space inside you
2. The space between you and another
3. The space between others
4. The space inside another.

A powerful de escalation tools is to first locate the anxiety. Where is it?

Often the answer is 'all 4.' Yikes!

1/

Anxiety is contagious, we spread it and escalate it unless we know how to manage it.

This was perhaps my biggest lesson as a trauma chaplain - the very hard work of not catching someone's anxiety.

2/

When I caught it, I was no good to them. I no longer saw what was going on, I was now 'infected' by my own triggers, assumptions, the story I tell myself. I was all wrapped up in myself.

But when I managed my anxiety, I was able to be calm, aware and fully present to them.

3/

Even in the very worst moment of their lives, even if they had me by the shoulders screaming, 'how could God allow this to happen?'

4/

Incidentally, early in chaplaincy, I thought this was an actual question. Because I was anxious, I was more infected by my need to answer than I was to simply be calm and present with them in their pain.

5/
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You gotta think about this one carefully!

Imagine you go to the doctor and get tested for a rare disease (only 1 in 10,000 people get it.)

The test is 99% effective in detecting both sick and healthy people.

Your test comes back positive.

Are you really sick? Explain below 👇

The most complete answer from every reply so far is from Dr. Lena. Thanks for taking the time and going through


You can get the answer using Bayes' theorem, but let's try to come up with it in a different —maybe more intuitive— way.

👇


Here is what we know:

- Out of 10,000 people, 1 is sick
- Out of 100 sick people, 99 test positive
- Out of 100 healthy people, 99 test negative

Assuming 1 million people take the test (including you):

- 100 of them are sick
- 999,900 of them are healthy

👇

Let's now test both groups, starting with the 100 people sick:

▫️ 99 of them will be diagnosed (correctly) as sick (99%)

▫️ 1 of them is going to be diagnosed (incorrectly) as healthy (1%)

👇
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Eli Tyre
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@EpistemicHope
I know some people who seem (to me) more concerned with receiving VALIDATION for their mental health issues than solving them.

They seem to care most about other people BELIEVING their problems are real.

I'm curious about this.

Like, it's more important to them that people know how debilitating their anxiety is, than to overcome the anxiety.

Or it's important to them that others believe that they're actually depressed, not "just sad."

Or they want people buy into the narrative that they've been traumatized, and might be something like offended if someone minimizes that.

What do we make of this?

1. One possibility is that if solving the problems seems hopeless or even just really hard, you need external support to be able to cope.

If no one cuts you slack because of your mental health stuff, maybe you're in a really bad place, so you need people to believe you.
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Ted Petrou
Ted Petrou
@TedPetrou
I gave masks the benefit of the doubt in the spring/summer of 2020. I have since changed my mind and see no scenario where it makes sense to wear them in public.

Even if they provided 100% protection, I believe masks to be harmful. An explanation below 👇👇👇

Let's say masks provide 100% protection to both the wearer and others (perhaps non-masked individuals) in close proximity. This is perhaps the worst scenario.

The immune system requires a consistent influx of both microbes and viruses to remain trained.

Halting the exposure to microbes and viruses is extremely harmful in the long run and leaves you exposed to enormous risk in the future.

Without training, you will become susceptible to even weaker microbes that your immune system would have normally handled with ease.

This is no different than laying in bed for a prolonged period of time. Walking up stairs, an activity that normally would not be a challenge, would all of a sudden become difficult.

Your immune system would slowly degrade similarly not able to complete previous tasks.

This is particularly harmful to children who's immune systems do not have the training of adults and would leave them more vulnerable. Children have the most life to lose so it harms them the most.
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Chris Yiu
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@clry2
I think that, in the face of an ongoing global health emergency and a pressing need to reopen safely, some form of health pass is a reasonable option to consider. But debate is a good thing, so here are some brief thoughts on various concerns I've heard about them... [thread]

"A health pass discriminates against people who have refused the vaccine." No. A health pass should also support proof of test result for people who haven't been vaccinated, and exemptions for people who cannot be vaccinated (get vaccinated if you can though, for heaven's sake).

"A health pass is an invasion of privacy." No. A health pass should be privacy preserving, allowing you to prove your status to third parties without giving away personal data or letting them track you without your permission.

"A health pass is unfair to people without smartphones." No. A health pass should accommodate people without a smartphone, e.g. with a printable option as a fall-back (though for most of us, carrying a digital pass on our phone will be much more convenient).

"A health pass will become obsolete as the virus mutates." No. A health pass should actually give us more insight and flexibility to adjust our response as our knowledge of the virus, and the ways we test / treat / vaccinate for it, increases.
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Avraham Z. Cooper, MD
Avraham Z. Cooper, MD
@AvrahamCooperMD
1/15
Why can cefepime cause neurological toxicity?

And why is renal failure the main risk factor for this complication?

The answer requires us to learn about cefepime's structure and why it unexpectedly binds to a certain CNS receptor.

#MedTwitter #Tweetorial


2/
Let's establish a few facts about cefepime:

🔺4th generation cephalosporin antibiotic
🔺Excretion = exclusively in the urine (mostly as unchanged drug)
🔺Readily crosses the blood-brain barrier (so it easily accesses the brain)

https://t.co/rjYG1BfGPR


3/
The first report of cefepime neurotoxicity was in 1999.

A patient w/ renal failure received high doses of cefepime and then developed encephalopathy, tremors, myoclonic jerks, and tonic-clonic seizures.

✅All symptoms resolved after hemodialysis.

https://t.co/u7JLVitQpp


4/
Cefepime neurotoxicity is surprisingly common, occurring in up to 15% of treated critically ill patients (w/ symptoms varying from encephalopathy to seizures).

💡The main risk factors = renal failure and lack of dose adjustment for renal function.

https://t.co/nxbnzSq8AR


5/
What about cefepime induces neurotoxicity?

One clue is that it's not the only antibiotic that causes neurotoxicity, particularly seizures.

This actually is a class effect w/ other beta-lactam antibiotics (including penicillins and carbapenems).

https://t.co/Lf4BhON9IY
HEALTH

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