Functionally Mental

When the Brain dies before the Body

Elisa A. Escalante/ LCSW/ 06-06-2026

“Maybe it’s not about the problems that can be solved. Maybe it’s about the conflicts in the mind that never go away.” -EaE

“Is suicide selfish?” They keep asking. “Suicide is when the brain dies before the body”, that’s my answer. It’s organ failure. After various compounding events, their brain decided that they needed to go. Suicide is not impossible to prevent, but it is hard to predict. And in the aftermath, everyone wants the answer to something that is so unexplainable. As if suicide is as simple as a ’cause and effect’, and there is one sure thing that we can blame. And if we can’t find something to blame, what then? We blame them for doing it and causing a wave of grief and reactivity.

I’ve worked in the mental health field for 17 years. As a mental health tech for the Air Force, as an intern at a family resource center, as a mental health therapist for the Veteran Hospital administration, as a research assistant a study on military suicides, and as a behavioral health consultant for the DOW. Talking to patients about suicide is a normal Tuesday for me. Though I have the field experience, and I have the professional education , I believe what truly makes me effective is that I’m not afraid to have the hard conversations.

I will sit with people for hours and listen to them talk about why they no longer want to live. Why the idea of not existing sounds like a relief, and why the idea of many more years of life sounds like a burden. And though the majority of people do not want to truly kill themselves, many people have fantasized about not existing anymore. The idea of death is a possible escape. Away From the burden of life, chronic pain, trauma, financial hardship, grief, mental health symptoms and complicated relationships. And why do suicidal people often not feel validated or heard? Because everyone around them is so terrified of the topic, they want to wish, will or push the conversations way. Or they want to toxic positivity them to death. And all this will create is more disconnect. I remember the last time I tried to talk to someone without depression…. about depression. Someone that did not have a suicidal thought in their life trying to hear me talk about my history of suicidal ideation. No matter how hard I tried, it was like speaking a different language. My friend doesn’t know this, but I ended up crying after the conversation because of the disconnect.

Mood disorders such as depression or bipolar disorder tend to have high rates of ideation. With bipolar patients, it’s often the inability to regulate their emotions and/ or predict their flair ups of depression and/ or mania all together. It can lead to a deep sense of helplessness and shame. With patients that have major depression, it’s the inability to care or feel joy in anything. The inability to convince the mind that life is worth living when there’s so much suffering and emptiness, and so little happiness. People with debilitating mental health symptoms accompanied by suicidal thoughts are being told to get sunlight, eat healthy, walk, hang out with loved ones, workout and think positive. What needs to be communicated is the fact that our brain is trying to convince us to die, while another part of our brain is trying to convince us to stay. And that is a conflict that no coping skill can remove overnight.

During my research with the Henry M. Jackson foundation for the advancement of military medicine, we can also see that suicide has various compounding factors leading up to the act. Mental illness, substance abuse, relationship turmoil, job dissatisfaction, legal issues, financial stressors, Childhood ACES. Compounding for years to decades. Some received mental health help first, some did not. Some left suicide letters or videos, some left nothing. Even teens have higher suicide rates! Some of the reasons include complex brain development, social isolation, bullying, increased mental health pressures, a horrible economy that makes the idea of growing up more terrifying.

Sometimes I call mental health work ‘The Art of Suffering Less”. And there are only two things I hope my patients do: Learn, and suffer less. I won’t expect perfection and I won’t be the added burden to an already hard life. I carry that philosophy even outside of the therapy room. I remember how the military used to break people down to the point of them having increased suicidal thoughts. I always wanted the military and the civilian sector to strive to be something descent and helpful, in a world full of suffering. What is in our control is how we can help people, or do no harm. Being generous, helpful, kind, or at a minimum, not being an asshole… maybe? Because why in the world would you want to be the Cherry on top of a shit Sundae in someone else’s life?

Most readers are not in a professional position, which means the textbook thing I need to tell you, is to bring your friend/ family or other loved one to the ER or mental health clinic if they inform you they are having suicidal thoughts. Don’t believe that you have to play therapist, it won’t go over well. But, you can listen without judgement and without pushing it away or trying to change their mind in a flurry with the toxic positivity quotes that have never helped anyone. In fact, sitting in silence would be better than that. Genuine presence is more effective than poor words. Being willing to play that small, yet significant role in the push to get them toward professional help, is so important. And if it’s you, the reader, you need the help too. You also deserve to suffer less. Do everything possible.

The Cave

Elisa A. Escalante / LCSW/ 6-11-2026

When PTSD is hard, it is inexplicably hard. But depression just might be the death of me. When these disorders combine, I go into a cave of isolation. It’s lonely in there, but it protects me and others. I’m protected from more triggers, and people are protected from me.

With a depression cave, I’m not allowing myself to be bothered by people that ask questions that aggravate my spirit. “What’s for breakfast? What’s for lunch? What’s for dinner?” Food. Who cares? The answer is not exciting and I am wasting energy by answering. “ When’s yoga? When’s BJJ?” meanwhile I’m in a crippling state of depression, I already decided I might skip my workout, and now I feel guilty because someone reminds me that I’m a failure, simply by asking a question. “Are you coming??” Someone may ask this about that social event I said “maybe” to, but now I cannot imagine going. It would be exhausting to pretend I’m happy, I would ruin the experience for everyone because I can’t smile. “How’s your diet?” I binged on fast food to regulate my emotions so that I don’t cry at work tomorrow. And now I’ll gain weight and it will be even harder to move my body. Wonderful.

People may say “you can tell me how you’re feeling”, but let’s be real. No one wants to hear these thoughts spoken out loud. The negativity would drive people mad. Which is also why the complex PTSD and depression combo leads to a deep sense of loneliness. My ex fiancé literally told me: “I’ll never date someone that has depression again”. (Good idea, and I’ll never date a narcissist with anger issues again. That made the depression worse)

I’ve lived with major depression for about 25 years. I’m very seasoned and extremely functional. I have done every single coping strategy and found ways to create those healthy atomic habits that manage it. I know enough to know that it will come in a crushing wave, but it will also go back to mild at some point too. I’m very effective with helping my clients with depression because I literally know how to manage it from personal experience. I give them more empathy, more grace, and more realistic strategies that won’t perpetuate the shame cycle.

Despite all the healthy coping, the cave will still be a necessary part of the depression process. We hide there. We rest and recover while our body is in a sad, numb, lethargic or dissociative state. We allow the tears to come, or coax them out if needed. I used to wonder what was wrong with me. If I’m so sad, why am I coming home, sitting in the dark, listening to the saddest song that was ever written, writing the saddest poem I have ever thought of while I smoke? Both my ex fiancé and ex BFF thought that this was an insane process. I’m only “making myself sadder”. Wrong. This was a ritual that my brain designed to get me through it. The cave is a way to preserve ourselves while we cleanse and let the wave pass.

Believe it or not, the depression intuition may guide us better than we realize. We are too busy shaming it to understand how effective some of the behaviors and compulsions are. Because when I allowed others to “yank me out” of the cave, they failed miserably. They aggravated me and made it worse. Forcing me up and out of my cave too early. Forcing me on a hike that my body wasn’t ready for. Forcing me to socialize when I can’t make eye contact, talk, or smile. Then they’re offended because their methods don’t work, the relationship is strained, the shame and depression go deeper. So, I’ll go into the cave when I need, and I’ll leave when I’m good and ready.

My Rules for Depression

1- Always have something to look forward to (literally have it booked in your calendar)

2- Move your body (in any which way you want and at whatever pace works for you)

3- Have a Social Hobby that’s low pressure & focuses on the activity, not mingling (martial arts, an art class, fitness class, karaoke or dance, a behaviorally activating hobby of some sort like woodwork, instruments, gardening, cooking etc. The key is to not be pressured to mingle while still getting the benefits of a social atmosphere )

4- Therapy (I almost insist), & Medication (optional but it could be necessary)

5- Find a Support group (this could even be online in free private social media platforms if necessary. Group therapy? Even better)

6- Change up your Routine (Depression breeds off of boredom and monotony. Stir shit up! Seek adventure and some occasional dopamine hits)

7- Force yourself to do a Self care Routine even if it feels pointless. (When it becomes a habit you will eventually see the benefits of it. The improvements could build motivation to continue. And the ritual may one day help you realize that you are actually quite deserving of self care)

8- Keep the Cave and create your personal ritual. It doesn’t have to look like mine, it needs to match your aura and feed your soul. That’s the best way I can explain it. I personally love Emo songs, Junk TV, coffee, writing, being around my cats, medicating, snacks, and my Pilates reformer. Where I can work my core in front of my TV/ music videos but I can move at a zombie pace.

Laughing & Crying Marine

5-30-2026

Interviewer: Elisa A. Escalante / LCSW/ USAF veteran / OEF Vet

Interviewee: Adam Walker/ Retired USMC / OIF Vet/ Author ✍️

Book “Laughing & Crying as a U.S. Marine” , release date: June 2026

Adam Walker is a retired Marine with 25 years of service to include 3 combat tours to Iraq. He is also a writer and a public speaker, which absolutely piqued my interest. I could immediately tell that this is someone that has a lot of wisdom to share.

Elisa Q- First, I always want to know the true reason someone decided to enlist in the military. Not the reason we tell the general public or the recruiter, but the real reason?

Adam A- I wanted to join the military since I was young. The sense of adventure was very appealing to me. As I came to age I just wanted to do it as quickly as I could. I had never traveled much, I wanted to be tested and to become a part of something. I also grew up in poverty where we lived paycheck to paycheck. I always say that because of the military, I went from ‘white trash’ to ‘middle class’. I did not have financial means for college, it felt like a leap to even consider it as an option at the time. Also, growing up, I never lived in the same place for more than two years. PCSing every two years was fine because not having permanency was very normal to me.

Elisa Q- When did you learn that you had a gift for writing and public speaking? And did the military nurture or hinder these talents? I think it can be bitter sweet for me personally. My military and mental health careers have always kept me time limited and interrupted my creative freedom, however, those experiences have also given me so much to write about.

Adam A- When I was a teen I would scribble write, and I had a knack for story telling when I was assigned book reports. I was a huge reader, which still helps stimulate my creativity. I was also a bit of a comic, I liked to entertain people with stories. The marine corps helped me nurture that. With recruiting duty I had to be outgoing and charismatic. As I went up in rank and was assigned leadership roles, I had to learn how to engage and motivate people. By the time I was a MSGT in the USMC, I was growing in public speaking. I was recognized and encouraged to submit to the Marine Corps Gazette. My first article was called Post combat Residue; in which I was comparing PTSD to the stain in a coffee cup. After I published this article, I received the Sergeant Major of the Marine Corps Writing Award in 2013. This boosted my confidence and I wrote 7 more pieces and received the same award again in 2015. Currently, I have a quarterly column in Leatherneck Magazine called ‘Lessons from the Smoke pit’.

Elisa Q- Laugh, lyrics, reflect and ramble were your original four categories on your blog “Takeitontheleftfoot”. What inspired these categories?

Adam A- It’s naturally how I write. I was thinking about how to organize every style and put my work in their respective categories. Humor/ funny stories, creating song lyrics, reflecting on something deep, or rambling. Now, with the book I’m publishing, 80% of it consists of my funny stories. Follow up Question: Do you believe that you use humor as a defense mechanism? Answer: I believe that humor can be both a defense mechanism and healing for people; myself included.

Elisa Q- I read ‘Home is Home’ which I found quite relatable. I also grew up, joined the military, and traveled far from home. There were conflicts between wanting to remember who I was and wanting to run away from it. As if moving and changing my career and identity could erase my past. I moved back to the Mojave desert in 2021, and I have a new appreciation for my home town. I love the nostalgic feel of the lyrics, what inspired it?

Adam A- I think I do get homesick a lot. The region of the blue ridge mountains in the southern Appalachians is where I spent a lot of time. Going out into the woods was a lot simpler than being at home where there was a lot of conflict going on. I camped, back packed, hiked. It’s simple in a way of respecting Mother Nature, and finding a way to survive in it. Finding a means to keep myself protected in whatever weather came my way. Nature’s beauty is therapeutic and healing. I sometimes have thoughts and emotions that hit me and offer me clarity, and I stop what I’m doing and I just start scribbling. Home is Home came to me this way.

Elisa Q- I read that you were injured in your second tour to Iraq in April 2004, You talked about a specific type of moral injury known as survivors guilt. The guilt of surviving when other fellow marines did not. Did you process your grief, repress it? How did it impact you, especially after returning home with many more years left on your enlistment?

Adam A- One, I was quite a workaholic. I felt guilty about my office job when I came back home after combat. But by being a workaholic, I felt like I was doing a service for those that I lost, and that were still in combat. I felt guilty for having a good life. There was a lot of recklessness and drinking, perhaps self sabotage. Not intentionally so, but the sabotage was my own punishment for coming home safe and alive. I believe many combat veterans do this subconsciously.

Elisa Q- Yes, and you refer to your post combat experience as the “angry and thirsty times”; Described as a season in your life that was impactful but brief? Trauma anger and …. a thirst for … what specifically? Medicine? Adrenaline? Dopamine?

Adam A- When I say thirsty, it is me being playful with words. I’m really talking about being an alcoholic. The underlying anger felt like being bitter, on edge and irritable. I kept it inside very well, people didn’t know. I drank for 8 years everyday. I didn’t show ill effects or signs, I was high functioning. Fortunately, I ended up getting a job where I stopped traveling, I slowed down and started working on myself. I realized I wanted to be better and do better. So the answer? The alcohol was medicine. I both laughed and grieved through the drinking and I slept a lot easier at the time.

Elisa Q- What do you think people should know about your book that’s coming out? How was the writing process for you?

Adam A- This book is for marines of all generations and for people that love their Marines. I wrote it in a way that will capture many people’s attention, including people that are interested in joining the Marines. I think it will help people understand through relatable short stories. A leadership book did not appeal to me. My method of writing was to make sure that I took myself solo camping every three months. I would then write as much as I could; this process went on for four years. And then my final year was figuring out how to get it published.

Elisa Q- Technically, you never stopped serving. Neither did I. We’re both still working for the DOW. Do you ever think about full retirement? Is it deeper than a paycheck? Does it still feel like a calling? A mission? Or a purpose?

Adam A- I’m making a living, I’m good at it and it’s stable. I would love to make a living out of writing but I’m not quite there yet. But at the same time, I’m not sure that I ever want to write for money, I fear that if I wrote for money I might then lose my passion for it. I also still like living in a Marine community, I have a lot of friends and a good social network here at Camp Legeune. I still go to the gym most mornings where I’m surrounded by my community. (Adam retired in 2019)

Elisa Q- Have you ever helped someone learn to appreciate writing for themselves? As a therapist, giving people the suggestion to journal to process their emotions is always hit or miss.

Adam A- No. (Laughs) But, I have encouraged people to commit to reading short stories. They may not be able to commit to a novel, but a two page short story can be inspiring and help grow their appetite for reading. I think many ppl see writing as a chore. They associate it with school and maybe they never did enjoy school. Not everyone is built for it. People don’t always fall in love with words.

Elisa Q: Any favorite song lyrics??

Adam A- Hootie & the Blowfish; Not even the trees.

Alone as I sit and watch the trees
Won’t you tell me if I scream, will they bend down and listen to me?
And it makes me wonder if I know the words, will you come?
Or will you laugh at me? Or will I run?

Little boy says to me, “Where you going now, son?”
I said, “I don’t know where I’m going, boy, I only know where I’m from”
And it makes me wonder if the stars shine when my eyes close
Or does my brother’s heart cry? I don’t know

(I love it and now I must listen to it!)

Elisa Q: Any words of wisdom or encouragement?

Adam A: I think every Veteran, especially combat veterans need to find a creative outlet. Maybe it’s fixing a car, home repair, gardening, or any type of art. It is a mechanism by which they can begin to heal; indirectly of course. The things they cannot verbalize are winding in the back of their mind, but the creative outlet can help bring it forward. Veterans used to destroy, but now they can create. For me, the outlet has always been writing and story telling. Deep down, I wish I also had music, so that I can produce some of the songs I have written. Maybe one day I can get into that too.

Elisa Q- What’s the next project for you?

Adam A- I do have a children’s story that I wrote a couple years ago. I would consider publishing it, I think it would be unexpected for my audience. I also have ideas for a historical novel. But I would need to develop as someone who does research so that I can create the novel with historical accuracy. I already have the story line and characters developed, but I don’t know if I’m capable of long form writing. It would definitely require some personal growth.

Jealous

Elisa A. Escalante/ LCSW/ 5-12-2026

I came across a very controversial stream of TikTok’s. The debate centered around a video in which a content creator admitted to being very jealous of one of her friends. She spoke about it so openly and honestly. She was vulnerable about it, I will admit. Some people praised her for her honesty and could relate. Others were heavily triggered by her honesty and urged her to seek therapy because she is… dangerous. Many people stated that it is normal for humans to feel jealousy sometimes, while other people said fleeting jealousy could be normal, but spending a large amount of time with someone that you secretly dislike, is abnormal and toxic.

There’s a distinction between emotions, thoughts and behaviors. The emotion of jealousy, like all other emotions, is normal and fleeting. Every human will feel jealous sometimes. But as I always say, our thoughts can be fabricated. And, our behaviors can be modified. The influencer not only expressed jealousy, but it became clear she had what is known as “compare and despair” thought patterns. She compared her life to her friends in a way that caused her to feel her friend is privileged, while she could “never be as lucky as her”. She resented her over time. And yes, this can be toxic. It’s a negative schema that promotes victimhood and resentment towards those that she perceives as ‘better off’.

In therapy, when my clients bring up jealousy, I encourage them to look inward. There’s three to four major questions I ask them to reflect on:

1- What do I fear? 2- What are my unmet needs? 3- Can I achieve what they have? If so, how?

Why are these answers relevant? They help get us back to ourselves and what is in our control. The questions can also help keep us from projecting our jealousy onto the person that triggered it. Because in the majority of cases, people are not purposely trying to make us jealous. It just, happens. It isn’t about the person that triggered the jealousy, it is about the core wound that was hurt within us.

The fears: When people are jealous, they tend to fear a multitude of things. It could be a fear of being rejected, a fear of being cheated on, lied to or abandoned. We could fear social rejection or embarrassment. Our egos are often involved in this. And if we act out due to our jealousy having an underlying fear, it often makes the situation worse. Especially because the majority of those fears are completely out of our control. Why are these fears so potent? Because technically it is a part of our survival. Our mental / emotional safety is just as relevant as our physical safety. Human beings need to connect, be accepted, be loved and so on. Our lifestyles depend on a society that accepts and takes care of us. But, if we aren’t careful and we let the jealousy lead to maladaptive thought patterns and behaviors, we could perpetuate the very thing we are trying to avoid: social persecution and betrayal.

The Unmet needs: The unmet needs that could trigger our jealousy? What if we see someone getting the attention that we want and have been deprived of? Or the money, success or promotion that we so desperately need. Or the quality time we have been begging for? The emotional attunement or the shelter/ security we long for? It can be hurtful and tempting to dislike the person who appears to get something we need, for minimal to no effort at all. But that energy we exert toward jealousy and hatred would be better exerted toward….

The achievements we want: If someone has something that we want, whether it be time, attention, success, promotions, we are better off finding out how we can achieve the same things. Rather than hating on someone that already has it. IF anything, that person could be our mentor, assuming they earned it. Or we can find mentors to help guide us in the direction we want. Sure, the world is full of privilege, but dwelling on that does not get us any closer to a goal that we want to achieve. Create a plan, goals, objectives and execute. Work on being calculated. And when things get hard? Remember that that is why so many people quit. That’s the process. When I see people achieving things that I want, I remind myself that it is because I have been slacking and allowing myself to get further from my goals. Maybe I became complacent or fearful. It has nothing to do with that other person.

Conclusion: If there is any take away, always remember: Feelings are facts, thoughts can be fabricated, and behaviors can be modified. Know the difference between the three. An emotion is a human response and meant to be interpreted, thoughts can be distorted and destructive if we aren’t careful. Behaviors can be harmful/ maladaptive so we must work on them always. They happen so quickly in a chain of events that quite often, people mix them up and believe they are one in the same. Break them down. Learn, grow, practice humility.

Mental Discomfort

Elisa A. Escalante/ LCSW/ 03-27-2026

Various mental health disorders/ issues require us to do the exact opposite of what we want to do, because we have the disorder. This is the strain of mental health. It isn’t rainbows and butterflies, rather, it’s pushing people to sit in discomfort, or to do the very things that may trigger them. This is why many people run away from treatment or avoid it all together. The idea of change, though hopeful, is very hard to do.

Depression causes people to suffer through low energy, low motivation, lethargy, lack of purpose, numbing, sadness etc. The last thing people with depression want to do is go on walks, get outside, plan social time with others, or explore ways to feel purpose. But, they need to do those things in order to simply ‘manage’ the depressive symptoms. Will they be happy? Not necessarily. They will manage it, still feel somewhat depressed, and tired while pushing themselves. It is vital that they give themselves permission to ‘zombie’ through their coping skills. Zombie walk, zombie chores, zombie shower, zombie hobby, zombie study, socialize in small spurts, and definitely get some rest when they complete their tedious tasks. Affirm that it is quite the accomplishment to still do healthy things even when their minds and bodies are working against them daily. They must always put something on their schedule to look forward to. They must always move, the pace is irrelevant. They need purpose, especially on the days where living life feels pointless. They need to stir up the monotonous/ boring routine with adventures. They need gratitude and positive affirmations as their mind plagues them with pessimism, brain fog, and or numbing. They need comedy and laughter to combat the misery. They need some solitude in order to recharge their social batteries but then have social time in spurts for connection and oxytocin.

Low Self Worth/ Self Love: How does one self love when they are filled with self hatred from their own childhood traumas? They lack the capacity, they were not taught the skills, they may be walking around with shame and the sense that they are burdensome and the abuse was their fault. They have self destructive tendencies, not self love. I believe to start in the right direction, we must recognize that self love could be unattainable, and perhaps starting with self acceptance is a more reasonable goal. It starts with using humanizing language, reframing distorted thoughts, while challenging outdated survival programs that helped solely when the patient was living in survival mode. Behaviorally, these patients will also have to ‘force’ themselves to do self care even when it feels unnatural or pointless. It has a backwards effect. They do not self care because they care, they do it because they ‘have to’, and in turn, it can turn into a habit/ ritual. The healthier self care/ grooming, over time, may change how they see themselves. What may first start as an obnoxious healthy habit that they ‘have to do’, can turn into very real visible benefits that they eventually want to keep up. Looking healthy will help them feel healthy. Feeling healthy will reinforce that the habit is worth the upkeep. Then they can humanize themselves and see that they are deserving of self care, and their body and mind are thanking them for the effort.

Anxiety: Anxiety leads people to talk themselves out of things, shy away from risk, and their minds are tortured due to thinking about all of the worst case scenarios. When it get’s severe, it could turn into full blown agoraphobia where they rarely or never leave their homes.; all to avoid the external danger/ triggers. The reason this perpetuates anxiety, is because if they don’t take risks, they don’t prove to themselves that they are capable of some things, or learning from mistakes without the world ending. If they do not step outside of their home, they do not prove to themselves that they can go out, have fun and stay safe. No proof of safety allows the anxious brain to convince itself that those concrete beliefs, are without a doubt, the reality of their world. Is danger a fact of life? Yes. It is happening everywhere? 24/7? Never. Also, cognitively, it works very much like a stereotype. The anxious brain is wired to danger seek, and therefore will ignore everything that proves it wrong and hyper focus on the danger/ risks that prove the mind correct. They also must remind themselves, through affirmations of safety, that they are living life, breathing, walking, running errands, and doing things where they end up safe, and still alive. They will still need their daily spurts of Non stimulation time where nothing is coming at them, where they can calm their sympathetic nervous system; deep breaths, meditation, aroma/ art therapy, journaling, reading, baths/ showers etc.

Raising kid’s with ODD: We can look at oppositional defiance in kid’s as a ‘survival strategy’. Now, what are they surviving? Too much overwhelming tasks; homework, studying, chores etc. What are they protecting? Their own energy. ODD is about energy conservation. This is why even when the chore in question makes perfect sense, the child might still resist it. Parents will grow impatient and frustrated and likely discipline the ODD child. Unfortunately, this will perpetuate the ODD more. When the child feels and believes they are bad, they act up even more. They also learn to not fear the risks of getting in trouble, so the yelling and discipline is not longer a motivator for them to ‘do better’. They receive lectures and chores from teachers, mentors, parents and coaches daily. But, where is the praise that can reinforce that doing positive things will help them feel positive and confident? Praising a ‘bad’ child sounds… odd, right? Praising them for completing homework, even if we believe it’s something ‘they just oughta do’ no questions ask. Praising them for not yelling/ kicking as much as they did last week. Praising them for when the school doesn’t call again with another complaint. Praising them for doing a chore they hate. Praising them for getting even one of their grades up. Modeling by example and showing them that doing healthy things can improve mood and the dynamics around them. A household that punishes all of the wrong doings, and never praises the accomplishments (even minor ones) will often perpetuate ODD.

Conclusion: This is why mental health work takes time to work. Imagine if in a first session I told a depressed person to ‘just workout and get more sunlight and talk to friends’? Imagine if I told an anxious person they need to push themselves and go out and take the damn risks? Imagine if I told the parent that is struggling with a difficult child to be nice to their child and treat them better? Imagine if I told someone that cannot love themselves to do the self care anyways? They would run away if they were over saturated with interventions that they do not believe they have the capacity to do. And, they would feel insulted. Like I’m throwing blanket solutions at complex problems. And, they are in fact, complex and chronic conditions. Some may require lifelong management. Before behaviorally modifications can even be made, we have to listen to why they exist in the first place. With empathy, with compassion, explore the parts of them that needed their survival strategies in the hardest/ darkest times.

CPAP Sleep

Elisa A. Escalante/ LCSW/ 3-17-2026

For the past couple of years, my family and friends have been urging me to get another sleep study. I procrastinated because I wanted to stay in denial. I did not want to learn that I have sleep apnea and will be required to wear a CPAP for the rest of my life if I wish to have restful sleep and normal daytime energy. I reluctantly booked the at home sleep study, because there was no way i was going to go back into another sleep clinic overnight and get hooked up to a million wires. (I did this when I was enlisted Air force and my originally sleep study showed no abnormalities) My test results lead to a diagnosis of moderate obstructive sleep apnea and I was told I wake up an average of 22 times an hour. Well damn.

When deciding on a mask, I already knew I would rule out anything that went over my mouth, ever since the military gas chambers I struggle with claustrophobia anytime something covers my mouth. I also did not want a mask that goes completely up my nostrils, also known as pillows. I also realized I do not want a mask that lays on the bridge of my nose, since I’m already a glasses wearer. This is why I chose option 3 from the picture above. It’s a nostril mask only that fits securely around the bottom part of the nose, and it has holes that point directly at the nostrils. The seal felt comfortable, and my consultant informed me that she wears the same one and loves it. Sold.

CPAP sleep

Day 1: I woke up noticing only mild fatigue and I didn’t need to hit snooze multiple times. I also did not feel too much dread about the work day. I had no fantasies of death, as I often have upon waking up due to severe fatigue. I did not have sleep drunkenness; where I am usually wobbly and walking into walls. My nose hurt because of all the air pressure, but it went away in 5-10 minutes. I arrived at work at 7:30 am, and started to feel awake by 8:45 am. Usually I do not feel fully awake until noon or later. In my mandated morning meaning, I was only slightly irritable versus being rageful as I deal with people wasting my time with useless morning announcements. When I got home after work, I had energy and motivation to workout and do some chores. Off to a good start.

Day 2: I woke up barely feeling tired. I moved at a moderate pace. I noticed again that I started to feel awake shortly after 8 am. I was happy to FaceTime a couple of friends between sessions or during no-shows. Usually my social battery cannot handle that. I was writing more notes between sessions very efficiently. I left work a few hours early to hit the road to go visit my family over the weekend and the drive was smooth. No fatigue.

The Weekend: For my weekend trip, I did not feel like packing the CPAP. I slept in at my own leisure. But I couldn’t help but notice the huge difference. I was so groggy and unable to get up or move well without the CPAP. I hit snooze 4-5X and had various stress dreams. I usually have the ability to fall back to asleep multiple times in the morning, some people have called me lucky for this. But it’s a very difficult feeling. It feels like my mind/ body are trying to drag me back into the dream world/ dimension. Like I do not belong in reality. I dragged my feet to go outside for a late morning walk Saturday morning. By Sunday morning I slept in even more and didn’t have the chance for a walk.

Day 3: Back to work Monday. And for a Monday, I felt alright. I did not feel the need to hit snooze. I went to work slightly nervous about a fully booked day. My energy level was normal by 8 am. I went into my initial visit in a good mood, I did not feel emotionally dysregulated throughout the day. I work with mental health patients so it is quite hard to stay internally calm at times. I’m a sponge of empathy and tend to feel the emotions radiating off of clients. If I am tired and grumpy, it will only make the day more tedious. I started to realize how silly I was for procrastinating on getting a diagnosis and treatment plan that has been very beneficial already.

Day 4: Today I hit snooze once, but I did not fall back to sleep. I got out of bed before the second alarm hit and shut it off early. I got ready at a quicker pace and left a little early. I went right to my 0730 morning meeting feeling ‘awake’ ish. I still don’t like meetings but it was bearable. I saw all six of my patients and I remained in an okay/ calm mood through most of the sessions. I’m at home right now getting restless. It’s time to workout again! I’m a little worried I may develop insomnia due to having way more energy but time will tell.

Surrender

Elisa A. Escalante/ LCSW/ 03-01-2026

At least once a month I receive another burnt out client with a goal to increase their productivity. This is obviously counter productive, but they are in denial. Some of the work ahead includes helping them learn to accept and surrender to their new reality. The reality being that they cannot keep up with their pace forever. Why? Mental, physical or emotional burnout, aging, mental illness that is impairing their daily functioning. When this is occuring, but the patient is holding onto the compulsive behaviors/ pace of a younger version of themselves, they are fighting against nature. When I inform them that relaxation practices would be more beneficial for optimal health in the long run, they tend to dislike the feedback. There are times in our lives where it is necessary to grind, push harder, go past our threshold and build stubborn resiliency. But, there are also seasons in life that are meant for letting go, slowing down; surrender.

Pacing/ Micro Dosing- These are just fancy terms for slowing down and doing things in spurts, versus all at once. People that have chronic pain, auto immune, mental health conditions cannot always perform an entire task all the way through with no breaks. They feel lazy if they cannot complete a task all the way through, but it is imperative that they respect their body. Our concrete internalized beliefs may create conflict. The idea that we must perform tasks at a certain pace within a certain time. Or creating a big mental to do list for tomorrow; a future we cannot predict yet. Making a goal with no way of knowing whether or not our symptoms will let us complete the task within our own imaginary time constraints. We need realism, we need to think about what is sustainable when we create new goals.

Calming the Parasympathetic nervous system- People are over stimulated, now more than ever before. Work, news, political climate, social media, people. I have talked with some patients that do not have a single ‘Non stim’ (non stimulating) coping skill. What does non stim mean? It means that nothing should be coming at us. No tasks, no requests, no people, nothing that promotes more wakefulness or stress to the body. Calming our parasympathetic nervous system is a must. Especially for busy working parents. Deep breathing, yoga, meditation, mindfulness practices, calm music, mindful baths/ showers or spa days. If we can master these practices regardless of how messy and overwhelming our lives feel, we then master the art of having control in chaos. How does this form of control become surrender? Because it is the only thing we can learn to control; our own minds and bodies. It requires us to give ourselves permission to let go, even when our minds and circumstances do not want to let us.

Letting go of toxic relationships- I validate that it is a very hard experience; to love someone that is self destructive and/ or harmful to us. When we love and care for people, we want to help them help themselves. But this can cause resistance. Though we may be able to see very clearly, the path that someone can take in order to improve their lives, it does not mean they want to walk that path. Regardless of love, safety and common sense, other people’s beliefs, ideas, and behaviors are completely out of our control. We will lose people we love. To substance abuse, to self harm, to betrayal. We may try to help them, and they may run away in the process, or hurt us for helping them. We need to learn when to let go and let them live. They have the right to self determine their own lives. The more we chase the temptation to ‘fix’ them or fix the relationship, the more we suffer.

Radical Acceptance- Everyone needs reminders of ‘what is in their control’ and what is ‘outside of their control’. Surrender requires acceptance. Think about self acceptance, other people acceptance, and life acceptance. We may need to learn to accept our own genetics, we do not get a say in that. We do not get a say in who our parents are, that is the ‘luck of the draw’. We must accept that other people can leave us or ignore us whenever they decide we are no longer of use to them. We may have to accept our society, our laws, our cultures. Or we can choose to leave and venture elsewhere if we do not agree with the confines of where we live. We must surrender to the reality that living life requires some suffering, and some work and effort toward self care. If we give up on ourselves and the reality of what self care requires, we then suffer more.

Humanize ourselves and others- Humanizing language means to acknowledge that we can feel tired, we can feel burnt out, we can feel a wide variety of emotions. De humanizing language sounds like “You don’t feel that way…”, “You shouldn’t feel that….” or “You arent’ tired”, “You shouldn’t feel tired….”. As a human, we can feel any/ everything. We can even feel things in parallel too; meaning multiple emotions at the same time that are conflicting. In grief we can still feel some relief with laughter. In love, we can still feel annoyed with who we love. We can have happy memories with someone and have memories that trigger anger as well. We can appear able bodied but be frozen in terror or analysis paralysis. Human beings are complex, not robotic. We do not have unlimited supplies of physical and mental energy. A part of the human experience is to surrender to our limitations. We can be humble, we can acknowledge and admit when we have needs. We can learn that vulnerability does not mean weakness.

CPTSD & Internalized Beliefs

Elisa A. Escalante/ LCSW/ 01-23-2026

Complex trauma in childhood tends to lead to internalized concrete beliefs that can rule our emotions, thought patterns and even our behaviors. Childhood traumas can include physical, mental, verbal, financial, sexual abuse, abandonment, neglect and or bullying. Below is an example of some of these concrete beliefs and how they manifest in the midst of chronic abuse.

I’m not wanted– This belief is common amongst kid’s that are abandoned, neglected or treated badly by their caregivers. Ongoing abandonment and terrible treatment can lead to the belief that we arent wanted by the very people that had us. As we get older, this could show up in our intimate relationships. We may have a hard time believing anyone wants to be with us even when we have concrete proof that they do want us.

I’m a burden– This belief happens when we are given life but then treated like we are an inconviencence or annoying anytime we have needs. We may then learn to shrink ourselves or learn to never communicate our needs. To have needs at all is now perceived as burdensome. This causes someone to go about life with the inability to self advocate. Their friends and partners will not have an understanding of their needs/ love language.

It’s my fault– Many kid’s that suffer from verbal/ mental abuse trauma will end up walking on eggshells in their household. When the perpetrator of abuse seems angry, the fear is that they ‘did something wrong’ again. It’s hard for a kid to comprehend that their parent may have anger issues due to multigenerational trauma, especially when that parent cannot emotionally regulate, and they project the anger out onto the child.

I deserve nothing– For kid’s that were neglected medically and/ or emotionally, they get the sense that they do not deserve anything. No tuning into their emotions, no giving them adequate amounts of food or clothes or shelter. Maybe even not enforcing their education or hobbies that could make them happy. They will be at a higher risk of growing into adults that have minimal coping skills and deep depresson.

I deserve pain– For kid’s that are physically and or sexually abused, they may believe they somehow deserved for that physical pain to be inflicted on them. They may be more prone to getting into abusive relationships as this was normalized to them growing up. They are also more likely to engage in self destructive coping or NSSDV- non suicidal self directed violence. As they learn that heavy emotions equates to inflicting abuse/ pain.

I’m unlovable– The neglected, abandoned and verbally abused children receive trauma instead of healthy love. How can they believe they are lovable when no one is loving them in a pleasant way? They may sabotage intimate relationships in adulthood due to the fear that the love they receive will run out. Or, perhaps they do not trust it all together because it is so foreign and unfamiliar; it cannot ‘be real’.

Everyone will leave me– Chronic abandonment from caregivers, friends and intimate partners over time will lead to this belief. How can anyone believe that people will stay with them if no one has proven it to them yet? This can lead to severe doubts anytime they enter a new relationship; a doubt that the ‘happily ever after’ is in the cards for them.

I’m not enough– Kid’s that are abandoned, neglected, or abused may believe that they ‘were not enough’ to be treated fairly. This one is quite broad. Because the question is, enough for what and enough for who? For a child, being accepted and praised by their parents is EVERYTHING. Without it, they may not have a healthy enough self worth to navigate their future relationships.

I don’t belong– A child on eggshells in their own home will get the sense that they do not belong there. Or maybe they do not belong with their parents or belong in the world. They may go about life confused about why they were born in the first place. Or they may feel like they need to search for a different/ new home far away from their caregivers, only to feel like they are in unfamiliar territory everywhere they go.

I’m invisible– When parents are overwhelmed with multiple kid’s, they may stop paying attention to the low maintenance child and focus on disciplining the hyperactive/ oppositional kid’s. Or, an only child that is neglected may feel this way. These kid’s learn not to speak up, because they start to believe that their role is to remain invisible for the convenience of the overwhelmed parents.

I don’t matter– What if everytime a child expresses their needs or vents about their frustrations, they are dismissed or judged? It truly won’t feel like their needs or wants are relevant. Their deep desires get swept under the rug. Their happiness is not taken into consideration. If it does not matter, they may not speak up about it again. They may stop asking for attention or love because rejection is… ‘inevitable’.

I’m the problem– If a child is blamed for everything, they develop the inner belief that they are always in the wrong. They are the problem and deserve the punishment or hatred. They may become more avoidant, so that they do not become a problem in everyone else’s life too. This impacts their ability to open up or connect to others as they get older. They may also get defensive as a layer of protection anytime they deal with confrontation.

I need revenge– For children that are severely abused and blatantly treated badly, their rage may take over. They develop oppositional defiance, or an inner rebel that must hurt those that hurt them. This is also known as reactive abuse. These are not inherently bad kid’s, they are kid’s that are stuck in a fight or flight mode loop, and their primal brain has chosen to fight back for self preservation.

I must remain silent- For the children whose words are used against them, dismissed, or judged, they learn to go mute. Silence ensures that they will get in less trouble, be less ridiculed. Silence also means peace, versus if they were to continue to talk back. Unfortunately, as they get older they will lack assertive communication skills. They are more likely to shutdown versus speak up.

Mental Punishments

Elisa A. Escalante/ LCSW/ 12-27-2025

Mental disorders are finally getting some recognition and empathy, but there is still a long way to go with educating our general public. One topic that is rarely highlighted, is how our mental illnesses can bleed onto other people. People do not choose to have mental disorders, it’s an unfortunate reality that many people must live through. And with these disorders, we may not always be aware of how our symptoms can impair our relationships. This blog is to help divide that gap. People with mental health conditions must understand how their symptoms impact the people around them. People that are in relationships with those that have mental health conditions would benefit from education regarding the symptoms so they understand that it is not on purpose, and it is not usually personal.

Depression can be caused by various factors. This includes a chemical imbalance, such as lower amounts of serotonin, endorphins and oxytocin. Social environmental stressors could include: chronic boredom, neglect, abuse, grief and abandonment wounds. Depression also has specific cognitive distortions that can perpetuate it: rumination’s, compare and despair thoughts, and pessimistic thought patterns. And from a behavioral standpoint, those that are often sedentary and spend a lot of time indoors and on screens will have heavier depressive bouts. In their relationships, the depressed person will often be unable to access joy even during fun times where everyone else is happy. People with depression may even have a good time, but be unable to smile or verbalize it. Their affect will appear to be bored, sad, or irritable. Their loved ones might interpret this as a genuine disinterest or a lack of gratitude. Their loves ones will also have difficulty believing that the depressed person loves them, as they cannot always feel or express their love. But the truth is they lack the chemicals, healthy thought templates and capacity to access joy.

Anxiety conditions come with a lot of nagging thought patterns and debilitating physiological symptoms. Thought patterns include future predicting, catastrophizing, mind reading, ‘should and must’ obligatory thoughts, and over generalizations. Somatic symptoms include heart palpitations, labored breathing, muscle tension, shakiness, dizziness and/ or migraines. Behaviorally, people with anxiety may compulsively google their symptoms and research conditions which could exacerbate their worries even more. They are also more likely to question or interrogate their friends/ family or intimate partners because they need answers. They need reassurance, and if their brain does not get answers, it will jump to conclusions or obsessively hunt for them. Unfortunately this could scare away or irritate their loves ones and perpetuate what they already fear; losing people, or being burdensome because of their anxiety. Other notable subcategories of anxiety include; performance anxiety, health anxiety, and social anxiety. If they avoid taking risks due to their fears, this is known as ‘sabotage’.

PTSD (Post traumatic stress disorder) is both a mental and physiological disorder that is caused by life or death situations, or chronic high stress situations repeated over time. It is a body and mind that has adapted to constant danger. More trauma, more triggers. Any/ everything can be a trigger; people, places, conversations (words, tones, phrases, pitch) inanimate objects, situations, emotions, thoughts, body language, bodily sensations etc. When triggered, their primal brain goes into the fight, fly, freeze, fawn or dissociate responses, and the frontal lobe shuts down. This makes it next to impossible to de escalate a situation as the triggered individual cannot access their prefrontal cortex. People with PTSD are known to be ‘reactive’, angry or ‘dramatic’ according to their loves ones. It’s important to note that people do not choose their triggers. Life, traumas and grievances decide those triggers. The person with PTSD carries the burden of having to regulate their bodies/ minds every single time they are exposed to triggers. Some people describe ‘walking on eggshells’ around the traumatized person, as they are afraid of accidentally triggering them.

ADHD (Attention deficit hyperactivity disorder) is neurodevelopmental and causes specific parts of the brain to not fully ‘mature’ in growth. The prefrontal cortex, amygdala and hippocampus are all impacted which can alter our neurotransmitters; causing chemical imbalance. Two behavioral themes often appear. 1- The ADHD patient tends to be so over stimulated by their surroundings that they cannot focus on a single thing and get pulled in many directions at the same time. Or, they hyper focus on one task for a very long time, and everything else in their life ‘washes away’, causing them to forget important things/ obligations. Their loves ones often get aggravated at their inability to do chores/ tasks in a timely manner, as well as their difficulty with being on time to even important functions. The individual with ADHD is usually trying their best, and may get aggravated at those that keep on lecturing them about the same things. Constant lectures from loves ones could also impact their self esteem and put them at risk of socially withdrawing.

OCD (Obsessive Compulsive Disorder) begins with the obsession in the mind that leads to tension in the body. Now, the body cannot relieve this tension or get rid of the obsession until they act out on a compulsion; a behavior. Once the compulsion is complete, only then do they feel a release. This pattern shows up quite often in home cleanliness, hygeine, safety rituals, and work projects. People with OCD are frequently described as ‘difficult to live with’, and ‘controlling’. They tend to desire that their loves ones do chores ‘in the exact same way they do’ and to the same cleanliness standard. If others do not follow suit, the obsession/ tension get’s aggravated again. They feel helpless when they do not have control and order around them. The unfortunate thing is they often take on the highest volume of work loads because they require it for their sanity. But also, some people recognize their impeccable work ethic and may even take advantage of it; this happens both at home and in work environments. They are at a higher risk of burnout due to this and they may also build resentment toward the people around them overtime.

Bipolar Disorder involves two very serious set’s of symptoms; depressive symptoms and mania. When depressed, they will have difficulty functioning, moving, or accessing joy. They may feel hopeless and have elevated guilt and suicidality. When they are manic, they may become grandiose, talkative, euphoric, hyper, compulsive and reckless. Genetics, brain neurology and social environment can all play a role. It is often hard for them to predict which mood state is going to take over. In turn, it can also be very hard for their loves ones to navigate the condition. There is emotional unpredictability, distrust, communication break downs and escalating arguments. Mood stabilizers can help, but many people that suffer with bipolar disorder have difficulty with medication management, as it has unwanted side effects such as ‘flattening/ numbing out their mood’, drowsiness, dry mouth and weight gain. It is another mental condition that no one deserves or asks to have, and to treat it requires unwanted side effects; a double edged sword condition. When manic, they may do things they regret that could also betray their partners; hyper sexual behaviors; infidelity, compulsive shopping; more debt, or substance abuse.

Never Thankful

Elisa A. Escalante/ LCSW/ 11-27-2025

“You walk through life while a rain storm follows. And all the while, people talk to you about the sun, as if you can feel it.”

I want to be more satisfied. With the world, with other people, and with myself. Trauma and depression were my greatest barriers. But, it is bitter sweet. Because it was also my trauma and depressive symptoms that led me to overcompensate. I also developed addictive and compulsive behaviors. I fill voids, I dopamine hunt, I make things happen. I chase the high of success. When I accomplished whatever goal I was yearning for, I got that fleeting feeling of happiness and satisfaction. But, the dark cloud comes back, and I needed to do it all over again. Then through life, I am given reminders. I need to be more positive and grateful. It could be worse. I should count my blessings. There are absolutely times that I can reflect on where I looked around me and I knew I had a pretty good life. But even then, depression plagued me. I hated myself for having a condition that I had no control over. When people tell you that it isn’t a choice, I promise you, it is not.

Through my professional career, I did plenty of trauma work and helped people through seasonal/ year round depression. It is important to highlight the themes that come up with any mental health disorder. Such as the theme of being in a room full of happy people, while some of us are so severely unhappy. That disconnect causes more shame, sadness and isolation. Who can relate to us? We have a rain cloud over our head’s while others are dancing in the sun. We’re breathing the same air, experiencing the same social environments/ interactions, and yet our internal world is so drastically different. I can say my gratitude’s out loud. I can acknowledge what is going well, but I cannot access the emotion of happiness. Therefore, I am acting.

Tips for Seasonal depression or major depression through the Holidays

Gratitude Lists– You won’t be able to practice gratitude everyday. And even if try to, it will feel forced. But on the easier days, it may be helpful to think about what you are thankful for. Whether the emotion of happiness is fleeting or not, there may be a situation in your life that is going well overall. Or maybe you will be able to catch ‘glimmers’ on a random day. A glimmer is a very small thing that could spark something in us. Sun rays, pretty grass or flowers, good weather, fresh air, something silly that makes us laugh. Take mental notes, or write it down on paper or in phone notes.

Budgeting– Financial stress over the holidays is quite prevalent. I remind my clients that a good holiday season does not have to be an expensive one. I personally believe frugal holidays are better because it removes the focus off of the glitz and glam and helps people stay grounded to what really is important. Quality time with loved ones, breathing, sleeping in and recovering from yearlong stress, eating with less shame hopefully! Secret Santa’s, White elephants and/ or setting strict budget caps that are agreed upon by everyone could be helpful and alleviate financial pressure. Or you can make gifts instead of buying them. An experience or an adventure can be a gift.

Movement– Yes we all need to exercise regardless of what time of the. year it is. Personally, I like working out during the Holiday season because I have the luxury of more free time and more energy. On a day off you will absolutely have time to workout. 10, 15, 20 minutes. Walk or gym or at home or at a class. It doesn’t matter. Make sure you do something you enjoy to help with the low motivation barrier. If you suffer from depression I highly encourage intuitive movement; Respecting and listening to your body to determine your workout. For example, today my legs feel weak, but I am sleepy. So I will be using my maxi climber at a very slow pace until I wake up. I may eventually push to a moderate pace depending on whether or not I wake up fully.

Filtering– People both in person or online are going to drive you crazy during the Holiday season. There are so many social rules. Opinions and judgements are at an all time high. Being around family could expose you to unwanted questions and unsolicited advice. You get to determine how much or how little you filter this out. You also get to determine your own boundaries and when you want to walk away. Try not to torture yourself by watching those rich influencers that are showing off the amazing/ clean part of their home and all of their presents. You can tune out your family members advice, or you can divert the conversation, or you can use assertive communication and let them know you have no interest in discussing a specific topic.

Vulnerable communication– This is one of the hardest things to do. People are absolutely terrified of emotional expression. The ability to tell someone how you feel and why, is scary. You could be judged, or invalidated. Your emotions could get swept under the rug. But vulnerable communication will either break the relationship further and teach you more about the boundaries you need… or it will strengthen a relationship in a beautiful way. You can tell people that you do not feel like celebrating. You can admit that all you want to do for your holiday off is sleep in until noon. If you don’t want to cook, don’t. If you don’t want to play pretend happy, don’t. Let people know where you are at. Let them know your needs. If you must go to an event, have a safety plan. Know the exits. Know where your time out room is going to be when you feel over stimulated or when your social battery is drained.

New Rituals– I love when people create their own preferred rituals instead of fitting in with ‘a norm’ that they do not like. For example, many years ago me and my father had an epic thanksgiving where we went to Las Vegas and we gambled and ate at buffets. Fast forward to the present, we both live alone; unmarried. So we keep up with this tradition. Gamble on a budget, food, no cooking! No hassle, no extra dishes. It’s our style. Also it means I get to sleep in versus wake up early to prep for a full day in the kitchen. I love when my patients tell me about their unique rituals. If on a particular holiday season they feel lost, I encourage them to make the holiday whatever they want to make it. Sometimes they sleep, sometimes they leave town. Sometimes they hang with friends instead of family. Sometimes they play games or create new social traditions. Be creative. Be yourself. Maybe you will create a memory that you can be thankful for.