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My only living parent has between one and five days left to live. The parent is unable to speak now and has had dementia for the last 5 years and will not recognize who I am if I go visit now in these final hours.

They live a few thousand miles away from me; it would be expensive to go and money is painfully tight right now with my partner unexpectedly unemployed and struggling to get a job comparable to the job just lost.

I’m somewhat estranged from this parent. The short version is this parent is a narcissist and really didn’t show up when I was growing up, or at any point in my adult life, or really at any point when it mattered. Despite this person being a really crappy parent, they exerted a massive gravitational pull in my life through many decades—basically, this parent loomed very large for far too long given the extreme narcissism, albeit much less so in the last decade or two. (Dementia and my coming to terms with it all and caring less and time and my having my own kids and my starting my own family all being some sort of salve.)

I have one very close friend who is telling me that it is critical to go before this parent dies because being present while they are still living will give me a kind of closure and unexpected resolutions that I cannot even anticipate now. This friend is quite adamant that going is critical for personal growth.

A different close friend says that going while the person is still alive is a complete waste and that I should go for the funeral instead where I can see other relatives and connect with my sibling and other relatives and deepen those relationships which (the friend says) will be a momentous transition point for us all, creating a better sense of family than any of us could have ever had while this person was alive. This friend insists that the healing and closure is identical pre-death and post-death, but that the extra emotional burden of seeing someone dying will derail me and never be able to be “unseen.” This person thinks spending money on two trips is foolish, so the one trip to go on is for the memorial. FWIW, My sibling is only going for the memorial.

Even if money were no object, I’m not sure I could emotionally handle going twice. I suppose I can, but that’s very time intensive and I have young kids myself who need me and for whom it would be a strain if I were gone for too long. I’ve already said it, but I have to say it again: money is really tight Going twice feels possible, but extremely difficult

I guess what I’m really trying to understand, if my feelings for this parent are presently ambivalence that grew over a decade or two from what was formerly extreme anger and hurt, is there something meaningful about going while the parent is still alive? Is there something important that happens before the person dies that is in someway healing or transformative or valuable? Is it more important to instead go when my sibling is going? Should I max the credit card and go twice? Should I risk infuriating and deeply damaging my relationships with my extended family and not go at all to save money? (This last option seems wrong, but it is a possibility, so I feel like it at least deserves considering.)

Friends of Tildes, what did you gain or lose from seeing a relative in hospice? What thoughts and wisdom do you have to share around moments like these?

Thank you in advance for sharing your stories. I’m sure your collective wisdom will help me make a better choice.

What have you been doing lately for your own fitness? Try out any new programs or exercises? Have any questions for others about your training? Want to vent about poor behavior in the gym? Started a new diet or have a new recipe you want to share? Anything else health and wellness related?

What have you been doing lately for your own fitness? Try out any new programs or exercises? Have any questions for others about your training? Want to vent about poor behavior in the gym? Started a new diet or have a new recipe you want to share? Anything else health and wellness related?

“Dopamine” has entered cultural conversations as roughly equivalent to “the feel-good brain chemical.” People talk about “dopamine hits” and “dopamine fasts” and “low dopamine.” In a recent conversation a family member talked about starting the day on his phone and scrolling feeds “because I’ve gotta get my dopamine up before work.”

There’s a seemingly widespread understanding that dopamine makes us feel good and that it can be used against us to make us do things we don’t necessarily like (like endlessly scroll feeds).

Is any of this accurate to how dopamine actually works in our brains? It feels like an oversimplification to me, but I don’t actually know.

It also seems odd to me that there’s so much focus on dopamine but not, say, oxytocin or serotonin (unless you’re a Billie Eilish or Girl in Red fan, respectively).

Is our lay understanding of “dopamine” efficient shorthand or pseudoscientific sleight of hand?

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UPDATE: the surgery went well amd she is recovering now

I talked in the past about my mother here.

She's been diagnosed with abdominal aortic aneurysm and keeping an eye on it.

Now it's time for surgery because it's big and in danger of rupture.

She's already in the hospital and will operate today or tomorrow.

She is still frail and eating less since my brother's death. Weight is only 44k/97lbs. She is 74 years old.

I keep reading that the endovascular surgery is not that dangerous. Just a minor cut in the groin, but I'm really afraid due to her weakness. Doctor assured is OK and he is the best in town. Last year he did 25 of these and this year 15.

Guess I'm just venting and afraid. Lost a brother a year and half ago and now it's my mother.

Feels like I'm just living between tragedies.

I’m really frustrated by recent experiences interfacing with the mental health system for myself and for my teenager. For them, it’s really atrocious. There may be effective options for the upper classes, but they aren’t accessible to me.

This is inspired by @X08’s recent [post] (https://tildes.net/~health.mental/1iia/unable_to_feel_progress_lack_of_happiness_and_not_finding_motivation_to_keep_investing) . Obviously I don’t know about their particulars, but I’ve certainly had the experience of being a part of a group where it appears others are progressing while I am not. Partly this is a problem of how we perceive, measure, and judge “success.” “Don’t compare my insides to others’ outsides,” as the saying goes. But it is possible to a more faithful and reflective comparison, and it does happen that others similar to me* make progress where I don’t, and it’s really frustrating. I’m often wondering, what’s wrong with me that I can’t change and grow?

I don’t have a great answer, although my exceptionally shitty childhood certainly plays a great role.

What I really want to comment on, though, is how insensitive our current mental health system is to the impact disparate causes have on creating similar symptoms, and how that should inform treatment approaches. A gifted psychiatrist (of which there are shockingly few) once put it like this (paraphrasing): Before we look at treatment for depression, we have to make sure the patient isn’t just surrounded by assholes.

But it’s a real problem. CBT is touted by a lot of “weighty” authorities as a valid gold standard treatment for a wide range of MH symptoms, and is claimed to be effective regardless of causes. And it’s my opinion that there is a lot of reasonably scientifically rigorous research backing that claim up. But, it’s not all rainbows, and it’s not working for lots of people. For one, a lot of folks claiming to do CBT are really not. Actual CBT involves a lot of homework, and a lot of recipients don’t have home support and don’t do the homework. This is extra true for children and adolescents living in dysfunctional homes. But more than just patient effort, the research marking CBT as so favorable is mostly based on subjects who are only mild to moderately distressed.* The end result is everyone involved in the “evidence based” healthcare chain is signing sufferers up for CBT when that might not be the best approach. There are lots of other criticisms too. If a practitioner is not well-trained and dedicated, the practice can be very invalidating. It seeks to make the sufferer’s more cognitive process more ‘rational,’ but when that person’s experiences are really, objectively bad, it’s very rational to conclude the world is hostile and unsafe. The tool itself is prepared for this, but it takes a really effective therapist to pull off. Also, it’s not enough by itself, grieving and other healing is also required for success.

The same thing happens in 12 step groups. AA/NA is resoundingly helpful-for a certain set of alcoholics/addicts. Those who don’t make it are often exhorted to become more honest, more open-minded, or more willing.*** My observation, though, is that most of the ones that make it come from intact families with resources. This is not universally true, it’s important for me to point out that there are enough examples of success among folks with no such background to say that there is something valuable in that approach that transcends socio-economics. There are also plenty from well-resourced families who don’t make it, but many of those families are highly dysfunctional. Of this last group, folks from dysfunctional families, some of us find success in other groups. This is because AA/NA are designed for sociopaths, ACA**** is designed for the product of sociopathic parents (who are filled with shame).

I don’t know what the solution is. A lot of malaise, addiction, “maladaptive” behaviors are, I think, born in a dysfunctional society, and so long as that society remains dysfunctional, no individual focused therapy solution will create a permanent fix. I think right here and now, too, we are at one of humanity’s “high tides” of self-destruction, a result primarily of runaway capitalism (is there any other kind?). We also just came through a really nasty global trauma, everyone is feeling it some kinda way.

Thanks for attending my TEDz talk.

*Of course, when talking about something as complex as a human life, there may no way to determine how similar is enough to make valid comparisons

**Also, let’s not talk about the various biases and implementation problems with what those studies refer to as ‘validated’ assessments used for measuring level of distress

***I am, technically, an NA success story

****Adult Children Anonymous, aka Adult Children of Alcoholics and Dysfunctional Families, more info at adultchildren.org.

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Two weeks ago I decided to cut alcohol out of my life. I have a weird issue though where I don't feel I necessarily relate to other problem drinkers in support spaces online, and I assume would not in-person, because I feel like my habit was never particularly bad. I've never been addicted to the degree where I have to have a drink to function, I never used it as a crutch in social situations, or anything like that. I don't mean this to put anybody down, but I've grown up around alcoholics, and even count myself among that number, but feel I somehow never fell into the worst, and have a hard time walking away from where I was because of it.

To break down my cycles of drinking:

I started with a beer a day. I liked beer, then moved on to drink/include whiskeys and other hard liquors. I'd have 1-3 drinks a night most nights from when I was of legal drinking age and could afford my own alcohol, and have a pace usually of one an hour. I enjoyed the tastes, experimenting with different varieties, and just exploring what was out there from whiskeys, cordials, weird beers, meads, anything.

Then there came a point where I started drinking heavily infrequently but regularly about seven years ago, where half a handle was gone in a week and a half and I had no idea where it went. I didn't black out at all, but would later realize I was drinking it really fast. This continued, I would stop buying hard liquor, and then buy some, and drink it quicker than I should have, rinse repeat.

The thing where I feel conflicted is I feel like I was in control, in a sense. I really enjoyed the alcohol I was drinking and would sip on it over a few hours having glass after glass. For these heavier nights I would wake up with a mild hangover, but it wasn't an every day thing. I would occasionally mess up and drink half a 750ml bottle and regret it, but tone it back down.

As far as cravings, I would crave alcohol like I crave other foods/drinks, like "I really want some Johnnie Walker Black this week" similarly to how I would think "I want a coke." Then I would clear 375ml in three days, and realize I didn't have enough to enjoy until the next paycheck (I generally didn't buy liquor more than once a pay period because I was usually interested in being more intimate with one drink at a time). Similar to how if I eat candy bars regularly I crave them, alcohol is/was the same.

Part of this led me to take a long time to give myself permission to stop drinking. I decided two weeks ago that I just don't need alcohol and sort of just said I'd commit to it, do the "one day at a time" thing. No end time, just never doing it. I feel if there's a deadline, or any conditions to drink, I'll slip back into the patterns I had which weren't entirely self-destructive, but not something I wanted to live with. As far as work functions, I'll just get a soda, mocktail, or water.

As a result, I have also hit a sort of malaise about how different things aren't. I've had dry patches where I chose not to drink, and I don't have a huge recovery story since I wasn't drinking all the time anyway, but going through these sorts of cycles. I don't feel any different because I'm not healing, I'm not going through any withdrawals or detox, I don't have any behavior to feel guilty about, or anything. I feel like a bad alcoholic, in a sense, because I don't have much to run from beyond the problem of "one is too many, two is not enough." I also feel self-conscious about not drinking alcohol, because I'm worried about how to answer if asked why.

I guess, to a point, I'm reaching out because I feel a little alone on this. I'm not sure how to navigate my not-quite sobriety (I still use cannabis edibles on rare occasion, and kava quite frequently, but not regularly). Has anybody else been in a similar situation? How did you navigate it internally?

What have you been doing lately for your own fitness? Try out any new programs or exercises? Have any questions for others about your training? Want to vent about poor behavior in the gym? Started a new diet or have a new recipe you want to share? Anything else health and wellness related?

What have you been doing lately for your own fitness? Try out any new programs or exercises? Have any questions for others about your training? Want to vent about poor behavior in the gym? Started a new diet or have a new recipe you want to share? Anything else health and wellness related?