Do It Anyways

"Do it in spite of your fear that someone is watching you". That's what my pdoc suggested I do when I become overwhelmed and suspicious about being spied on by my work.

I have been so stressed out with my depression and with my Mom's terminal illness. As she becomes more ill I become more depressed, as I become more depressed I become more suspicious of others. It is to the point now where I am constantly scanning everywhere I am to see if someone is spying on me. I close my curtains so no one can see in my living room. On the ferry the other night I was sure a man behind me was taking pictures of me with his cell phone. In the laundromat yesterday I became very suspicious that a lady there was following me.

One part of me can (sort of) see how crazy this is, but the other part of me insists it is true. I think much of my feelings, especially how specifically the thoughts are linked to my work, are linked to how guilty I feel for not getting better, and my fear of being judged by others as doing something wrong. I have to know in my heart that I tried my hardest to remain at work, even when I was extremely ill. I saw numerous different therapists over a number of years, tried medication, decreased my work week to 4 days a week...all at my own cost. I also have to remember that I am trying my hardest to get better. That is all I can do.

Anyways, today I decided, even though I "sensed" I was being watched, to open the curtains and defiantly be and do whatever I feel like, even if I am afraid.

Acceptance

In my last session I asked my pdoc if he thought my medication was helping me. He said, "I don't think it will be any one thing that will help your depression". I took it to mean I need to do lots of different things (medication, more socialization, art, writing, etc.). His body language and the tone in his voice looked and sounded sorrowful though, like he was trying to tell me my depression may never go away.

Last night I woke up thinking about our discussions in previous sessions about acceptance and about really taking advantage of the times I do feel okay, about not allowing the good, or relaxing moments to be muddied by guilt, or stress, or paranoia...I know, I know...easier said than done.

I realize now that I may be severely depressed forever, and I may need to learn to live with that. or live around that. Not quite sure how, and I really do not want to, but I suspect I have to accept was is.

Rage

ROOOOAAAAARRRRRRR! 

(Picture from University of Saskatchewan...May be copyrighted)

I had a dream last night. It was dusk. That exact time of night where you cannot see anything clearly, not dark, but not light either. I was in a yard crouching by a hedge when I saw a man walking towards me with a massive grizzly bear on a leash.
The man accidentally dropped the leash and the bear escaped.

I saw the bear racing towards me and I dropped to the ground. I thought if I could stay perfectly still the bear would not see me. I was so still I could hear my heart pounding. I was so scared every tiny move I made was projected one hundredfold. The bear tried to grab me and I ran.

I ran to the house, climbed onto the window sill, then up onto the porch and finally onto the roof. The bear was raging angry and began to rip boards off the house. With the tremendous power in his paws he ripped the whole house, walls, porch, doors, roof, apart except the frame. I clung to the top of the house terrified and then I woke up.

In my appointment today this dream came up. I thought of me as the scared person on the roof, but if I look at myself as all the characters in the dream I am also the person who released the rage, and the person raging. I believed my depressed persona is the person afraid of the rage.

I have so much anger inside that I am afraid to let it out. I am afraid of its power and its potential for destructiveness. I often feel like I am a volcano about to explode and destroy everything in its path. I get these intense desires to destroy things, to hurt myself, to kill myself in really violent ways. They are only thoughts, but all the feelings of rage come with the thoughts. I feel so afraid I will lose control and destroy everything around me, just like the bear in the dream.

My pdoc says I need to be able to feel the anger, without releasing it in a destructive way. I do not really understand what he meant. I am not one to destroy things...I DO just FEEL like destroying things...and it is an awful feeling. All I want is for the anger to go away. It is not me.

Wellness Within

My Mom came to my Pdoc appointment yesterday. She is dying and wanted to know if I am, and will be, in good hands. She also had some concerns about how dependent she felt I was on my Pdoc.

She told him her worries and he said, in fact he encourages a maternal type of dependence. The type of dependence that will allow me to feel safe enough to grow. He and I have discussed this issue at length because I am what he calls, "fiercely independent"...(translation...stubborn)...and I hate being dependent on anyone or anything.

Part of why leaving my job was so hard is because I had to give over my autonomy to some degree. Suddenly I am not in control of my financial situation. Given my current inability to work the insurance company and the government are who I rely on financially. This stresses me out, so much so that I see people spying on me all the time. I feel like I am being watched. I feel like they are looking for any excuse to boot me off insurance before I am well enough to take care of myself.

Last month the insurance company sent a letter to my pdoc asking for all his notes from all our sessions...this freaked, and freaks, me out. I was forced to sign an authorization to disclose the information, or I would not receive insurance. So much for "consent". I feel so unsafe now and wish I had not said some of the things I did about feeling I was being spied upon, about not liking my job, about being afraid of losing my insurance etc., etc.

On a more positive note, at one point in my session I said "When I get well...". Dr X. looked at me, and at my Mom, and said, "You have wellness inside you, as do you" (to my Mom who has just been diagnosed with terminal cancer).

I thought about it. I now see that for years I have been working to try to achieve some state of mind outside myself, looking to be someone different from who I am, looking to somehow be a different entity all together.

What Dr. X was saying is that I have wellness inside me already. I just need to grow and nourish that which is already there. I found this a very profound, Buddhistlike thought.

May You Get What You Want

I am such a flip flopper...Now I am feeling all stressed out again about my appointments being cut back.

I started to feel like maybe he is punishing me for something...I even asked him a few weeks back to be a "punishing therapist"...isn't this where that old adage "be careful what you wish for" comes in??? There is an old gypsy curse, "May you get what you want" that reflects this thought too. (I love that curse...except of course when it pertains to ME!!!)

What would I be being punished for???...

• The med screw ups I have had in the last few weeks. I got into the valium again...and I have trouble with benzos and withdrawal...but I was/am soooo depressed and soooo stressed out. I just did it to relax a little. Anyways...I'm off them now...and when I took them he said we could try it with the gabapentin and modafinil to see if it was a good combo...so I did not think he was mad at me.
• Maybe he read my blog and thinks I need to stop thinking about him and therapy so much.
• Maybe I wear on him. God knows I can't seem to get better for some stupid reason.
• Maybe I'm doing something wrong...not sure what, but I always feel like I am doing something wrong and about to get caught. I always feel like it is my fault that my depression won't go away, or get better. Feel like I am not trying hard enough...even when others say I am trying too hard...I feel so useless and tired all the time. I cannot seem to get going on anything.
• Maybe I am making the medications not work? Not sure how...maybe I do not believe enough that they will (My husband constantly screams at me that they won't), or maybe I am too picky about the side effects. I feel like I try really hard to let them work...but I simply cannot function on most of the meds I have tried...either I get so tired I cannot do anything, or I get so anxious I get even crazier...or nothing happens and I remain severely depressed.

Anyways...I guess we (he and I) are going to have to have the "I feel rejected/abandoned conversation AGAIN...because obviously, while I thought I got it, I don't

Freed Up

Okay, I take back all the negative things I said last time. I was not being abandoned. I was being "freed-up".

I am so proud of myself today. I was brave in my session today and brought up how I left the session in shock...wondering how, when I was brave enough to ask for a change to accommodate my needs, I left feeling like I had been dumped like a hot potato. His response: "I did meet your request to change appointment times very enthusiastically with a response that meant cutting our sessions from twice to once weekly". I was confused and asked him why he was so enthusiastic...explaining I was feeling like I had burdened him too much by remaining depressed for so long and that that was why.

My Pdoc explained he felt that it might be a good idea to shake things up a bit. He thought it was a valid trial, just like a new medication trial, to see how the amount of therapy impacted my mood. He also mentioned that he tends towards being a passive therapist...meaning he tends to sit and listen to the patient vs. taking the lead and making decisions for them. He said he would not change that, and likes that about himself, but he wanted to try a little less passive approach to see how it went.

I have to agree with him on both counts. While I am still really stressed about going from seeing him twice a week to only once a week, I think his decision for us to try therapy one day a week is a sound move. Also, the reason he is a great therapist (and the absolute best I have ever encountered) is that he is an incredible listener (what he labeled as "passive"). He has this innate ability to listen and to allow the patient to make their own decisions. That is not to say he does not step in and help when we need it, or push when we need it, but he understands indecisiveness and amotivation are symptoms of depression and cannot be overcome by making the patient's decision for them. There is nothing worse than a therapist who tells you WHAT to do and WHEN to do it. I need to make my own mistakes, thank you very much.

I asked him if he was honest with me and told me the truth all the time? I wanted to be sure that I could trust him when he tells me I am not overwhelming him with not getting better. I worry I burden him. He said, absolutely he was honest with me, and he believes he would always tell the truth, even if the news is bad, (although, he said he would find a constructive way to bring that up). He said the only time he might not tell me the whole reason behind something is if the reason was a personal reason, or troubles he was having...he said that would be irresponsible of him to use my time, or to impact me because of that.

At the end of the session my pdoc asked me how I felt the session went. I told him I felt really good about being able to bring this up, and that I was glad he was open to the feedback. In fact, the second I saw him in the waiting room, I knew he would be and I knew I could safely discuss all I was feeling. I tend to get overwhelmed by change and I think my thinking was coloured by that. I also think one of the biggest reasons I was feeling so scared was because I feel so safe in his office. I translate that safety into a belief that I need MORE safety (i.e. more appointments).

In fact, when I am extremely depressed sometimes I fantasize about laying on the floor in my Pdoc's office...just being in a safe place, where I can just be, and not worry incessantly like I do in the outside world. My Pdoc made it clear today that we can always review the number of appointments we have together and we can always talk about these sorts of issues...in fact he said they are some of the most important conversations to have. I am going to try really hard to make this change a positive one.

Blind Sided

I don't know what happened in my session yesterday, but I left feeling pretty much blind-sided and abandoned.

Last Friday I left my appointment feeling like my psychiatrist was extremely supportive, caring and very empathetic. I felt he really understood how much I was fearing being abandoned and ending up alone. I felt really cared for even though I was so upset and sobbing much of my session.

On Thursday last week I received a call from an Art Therapy Program I go to saying my name had come to the top of the list for the next acrylic painting class...Did I want to take it? I had refused once before as the time conflicted with one of my appointments and when that happens you go down to the bottom of the list again. So this time I thought two things:

• I really want to take this class...and creating art does seem to help me
• I was feeling brave enough to actually ask my pdoc to accommodate my need for a different appointment time so I could take this class and still see him twice a week. I have such a hard time asking for any sort of accommodation from anyone I even perceive to be the slightest authority figure...so this would be hard for me to do.

So after carefully practicing how I was going to ask for this, I went to my appointment, sat down, told him about the Art Class, and asked if I could change my Tuesday appointment time. Immediately he says, "How about I see you once a week on Fridays. If you find you need to see me more we can arrange that then. I am really flexible with my hours and you can call me and arrange another appointment if you need it".

I am sure to those of you reading that statement you are thinking...sounds totally reasonable and supportive....but you don't know my history around this whole twice a week appointment scenario. I will not call him...and he knows I will not call him. I would not call him if I am about to commit suicide...so I am not likely to call to say, "Help, I need an extra appointment". I have cut my appointments down to once weekly before and I always lose it and get even more depressed.

The thing is...I do not understand why now? Why is he cutting me off when I have been so depressed recently. I feel like I can barely hang on right now. Why is he abandoning me like this right now? He said he wants me to expand my horizons, that he knows I have limited energy because of fatigue and motivation and wants me to spend my energy on things that make me feel good. He worries that the time I spend in therapy drains me of my energy. What the FUCK???

I feel (usually feel) supported and cared for in therapy. On days I have an appointment...Tuesdays and Fridays...I actually leave my house and get into the city and do things before and/or after my session. My sessions helped me do, and feel safer doing, other things. In fact, less than three months ago I was concerned that I was too dependent on him...his response..."Wasn't it important to have someone to come to, someone you know supports you, someone to lean on when you are out in the world trying to do the things that scare you"?

I feel like something weird happened. I do not think he is being honest with me. I think he saw an out and took it as quickly as he could. I feel totally let down...and angry that when I am so severely depressed, (but finally had the courage to ask for him to change his schedule to meet a need of mine), I got shot down in flames.

...Aqua

Another Failure

Another failed medication trial...and the list of failed treatments and meds grows to 25 plus meds, ECT, years and years of therapy...argh! My husband has been raging mad at me. Thinks all I need to do is "stop worrying so much", or, "just stop thinking about your depression"..."The medications make you worse", "You have never been as depressed as you have been these past 5 years since you started to take the medications".

I am so depressed I do not have the fight in me to argue these points anymore. When he starts his anti-med, ant-psychiatry rant I feel intense rage inside, like I am going to explode into a million pieces. I feel intensely criticized and in turn guilty for not being able to get better. Does he really believe I would remain so depressed if all I needed to do was "stop thinking about it"?

He fails to comprehend the extent to which depression takes over my mind. For weeks now I have been plagued by extreme suicidal ideation. Feeling unable to keep trying I set up extravagantly detailed plans on how I could go in the least painful way possible, but ensure total success. Then I begin to rage at how unfair it is that I feel so sad and my plans become more violent in nature...aimed at punishing and killing myself in the most violent ways possible.

I am stuck here though because I cannot do this to my family. Having the thoughts over and over and over, but being unable to act on them is like being stuck in hell. I want so bad to go, but know I never will be able too. I wish there was a switch to shut off my thoughts when the ideation starts.

I feel ashamed at having all these s. thoughts...and while I discuss them with my pdoc I leave out details because I feel like I am being so childish and weak. I feel I should be able to stop these thoughts, to overcome my depression, to get back to work, to get out and choose to live.

I do not understand how I went from an intelligent, vivacious, life loving person, with a promising future...to someone who is unable to work, lucky I can get out of bed and out of my p.j.'s many days, and so tired, fatigued, anxious, irritable, depressed all the time that I am unable to do much of anything anymore.

While arguing about my depression getting worse my husband started to talk to me about separating the other day. He sounded very serious. While I have brought the subject up before, because I am certain his constant criticisms of me and my psychiatric treatments have got to have a negative impact on my ability to get well, this was the first time he ever brought the subject up.

I felt distraught and spent all night thinking about how I was going to have to live in my van. Visualizing being cut of disability insurance, having no money, having nowhere to live...I could see myself ending up on the street. Everyone tells me these thoughts are irrational. I do not feel that way though.

I feel like the possibility of a descent into homelessness is simply a matter of degrees. All it would take is a loss of income, or such a small disability income that one could not afford to live and a loss of a sense of interpersonal support (just like how when I am depressed I isolate myself, but also feel isolated from everyone too). When I severely depressed and isolated I do not reach out or ask for help. When I am severely depressed I cannot see viable solutions to these kinds of predicaments.

Anyways...I'm here, not living in my van yet (at least I have a van to live in..ha, ha) and I'm going off the last of 3 meds in my latest combo...I suppose preparing to try something new. Please let the next medication work!!!

Daydreams and Horoscopes

I was just sitting around reading the newspaper. Well actually half reading and half daydreaming, thinking about how to move my life forward. Thinking about how my psychiatrist is telling me he thinks I would be motivated to do more if I had some external motivation. He was not talking about a punishing type of motivator, not something that represents the militaristic style of your father, but a more caring version. So I have been thinking of ways to set up my life so I have some external motivation.

One of the things I long for is to be able to return to school. I love to learn, I loved university. Honestly, my last two years of university were the best two years of my adult life. My classes were so interesting. I felt challenged and exhilarated by the lectures, the essays, the discussions (exams sucked...but hey!).

I want to take a class. However, I get so freaked out about going to school, or committing to anything because my mood is so unpredictable. Some days I feel able to do anything I want to do. Most days I feel I will fail at anything I try. Concentration and memory problems plague me , so I worry I will not be able to manage the reading, or recall enough to pass the exams. I often get mired in a perfectionistic nightmare...obsessing over and over about what I have done wrong with the work I hand in.

I remember giving my psychiatrist a copy of an essay I had written for a class I took a few years back. The second I walked out the door I felt sick for having given it to him. I immediately "knew" he would think I was stupid and incompetent. I obsessed for two weeks about how awful the essay was, and how I had destroyed his perception of me. In the end I received an A+ on the essay, but I still thought it was a crappy essay and that I received the mark for some reason other than my competence.

Anyways...(got a bit off track there)...While daydreamingly reading the newspaper this a.m. I started thinking I might like to try auditing a creative writing class. I reluctantly flipped to the horoscope page.

Reluctant because, have you seen how brutal the Gemini horoscope has been for the last few weeks? Everytime I open the paper to read my horoscope in the past couple weeks it has expressed that my vehicles will have mechanical problems, it threatens that I will have trouble with insurance companies and financial organizations. ...God give me a break...I am already afraid to answer the phone or go to the mailbox, afraid I will get some awful news about my disability insurance being cut off, or that I need to see one of their psychiatrists, or whatever...

Man, off track again...Anyways, the point I wanted to make in this whole long winded post was that I daydreamed about taking this creative writing class the whole time I was reading the paper, wondering if I could do it, if it was a good idea etc. I flipped to the horoscope section and the last line of today's horoscope read..."Creative writing is a great choice" Perhaps that is a predictor of a fortuitous change in my life...hmmm?

Punish Me (please)

Today I barely made it to my session on time. Used to be I would leave my house an hour early and arrive with at least 15, or 20 minutes, to spare. Gave me time to grab a coffee, get my thoughts in order, and calm down from the drive into the city...(insert all sorts of expletives here focused at all the bad drivers that seem to fill up the city I live in).

Anyways, lately I am leaving the house later and later, arriving at my pdoc's with minutes to spare, if that. I do not think this is a coincidence, but I am not %100 sure why I am unconsciously trying to make myself late:

• Trying to shed my "good girl" image with my pdoc?
• Rebelling about "having" to go to my appts (obviously it's my choice...but I can see how in many ways the choice is only as free as my feeling that I will survive without the support)
• Feel like what's the point of going to my appts...It's been 4 years and I'm still depressed
• Feel like I have nothing left to "entertain" my pdoc with...God it must be so boring to have to listen to me say the same things over and over and over...
• Maybe I am ready to leave...and just practicing...NOT!
• (Most likely)...I want to end the therapy before I am abandoned...either emotionally...(boredom, disgust, negative judgment etc.), or physically...(pdoc moves, or something happens to him, or he decides he does not want to see me anymore because I am not trying hard enough)

This fits with my sessions opening comments...I need a therapist who is more punishing, so I feel forced to do things. "What does a punishing therapist look like", pdoc asked me. (all sorts of explicitly sexual images came into my mind immediately...I will tell you why another day)...but I digress...

A punishing therapist lets me know there are consequences for not doing things. "What kinds of consequences?", the unpunitive pdoc asked. I explained, "if I did not do what I was supposed to do, then my appointments would be cancelled, or you would stop seeing me. I get things done when I am afraid of being punished, maybe that would help me here". I was being a bit facetious, but in many ways I feel like I would try harder if I was being "managed". I am simply not accustomed to being so accepted no matter what I do, how I act, what I say, how I feel.

My pdoc says there are many types of parenting styles...The tyrant style...where the parents tyrannical behaviour places their children in a state of constant fear, and guardedness. Effective in the short term because the kids are afraid to do wrong. However, the children will likely rebel and become wild when they leave home. Then there is the opposite style, those parents who set no boundaries, and their kids run wild and get into all sorts of trouble. Then there is a more balanced style where the parents set boundaries, but also allow there kids to grow and explore.

My father was the tyrant...I was terrified of displeasing him...and when I left home I became wilder than wild. As I get older I have become my own tyrant...I use guilt and self recrimination to egg myself on, to try to force myself to do things. What I end up doing is feeling more guilty and more self hatred when I fail to move forward. So I guess I am thankful that every Tuesday and Friday I have a pdoc who attempts to "refather" me from a moderate parenting perspective.

Paranoia

I became all paranoid last night and could not get to sleep...Midnight, 1:00am, 2:00am...argh...All I want is to be able to sleep.

I feel exhausted all afternoon and evening and then I go to bed and it is like my brain switches to overdrive. My thoughts start racing. I start thinking of everything that went on during the day and all the negative nuances to every action, or discussion I have had during the day become magnified.

Last night I started freaking out about my session. My pdoc told me about how one of his patients was feeling better, "but she would not think that was the case". I started wondering what the consequences would be if he thought that of me, but I still felt depressed.

What if he told the insurance company I was well, when I did not feel well? What if he tried to push me when I was not ready? What if I ended up back where I was when I was working? All I wanted to do then was kill myself, because I saw no other way out. I have this brutal work ethic. I simply could not get myself to leave for medical reasons. I felt I could not let everyone down, including myself. I felt like leaving was admitting failure and no matter what I could not let myself or other down, even if it was looking like I was going to literally kill myself at work.

I began having fantasies, and setting up plans to hang myself in the handicap washroom at work. I increasingly started writing letters to my family in my diary, explaining why I could not go on. I had a huge stash of different benzos and other psychotropic drugs. I had detailed, easy to do, plans on how to drown myself after taking all kinds of sleep meds. I was desperate for relief, but for some reason I identified myself so closely with my work, that I could not get myself to leave work to take care of my health.

I am so scared I will end up there again.

Be Like a Tree

I ended up having a pretty good session today, despite it starting off poorly. Some days I just don't have anything to say. Today was one of those in the beginning. I just felt so flat and blah...better than the two days prior though.

I went off my Epival (mood stabilizer) to see if the other med (Gabapentin) would work on its own with less side effects. I think I was angry at my pdoc for making me do this as since I have taken the Epival I have at least made SOME progress...even though I also pay the price of memory/concentration problem, hair falling out in clumps, fatigue, amotivation and as well as it possibly causing rapid weight gain. These may seem huge...but the constant suicidal ideation and the severity of my depression were so much worse before the Epival. I feel like I was willing to put up with some of those things.

Now...last couple days I have been so angry and depressed I started having all my suicidal thoughts again. I was mad at pdoc because Gabapentin does not have a great reputation for helping depression...(supposedly no controlled studies show it helps better than a placebo)...also I am now on only the one med which while wonderful to be on one...is counterintuitive to all that I have read about treatment guidelines for refractory depression... and I have been so treatment resistent to every med I've tried except Epival...Even the people I know with mild/moderate depression seem to be on a couple different meds as one doesn't seem to help. So I guess I don't get how the Gabapentin is going to help me, but he's the pdoc so I guess he has a plan.

Anyways...I had the courage today to ask my pdoc (after 4 years of trying to figure it out on my own)...to ask him if he could please tell me what I am doing wrong. How can I help myself. I feel like I am blind AND I have been placed in a maze, and I'm trying to find my way out...the effort is futile. I asked, "Can't you please just give me a push? I want someone to tell me how to help myself.

He said my question presupposed he was not pushing me. Then we had a big discussion about how important external motivation might be to help me get going. He used the metaphor of how a tree draws water two hundred feet up to the top of itself. He said, "Nothing from within the tree forces the water up its trunk. Evaporation pulls it up. Something outside itself sustains its continuing to survive and grow". (He always has awesome metaphors!) "If someone was relying on you, if someone needed you to be there at a certain time, it might be a motivation to help you move forward".

I see what he is saying, and I know he is right...but this freaks me out because I am so scared I will end up in the position I was in before I left work. Highly suicidal, but I could not, no matter how hard I tried, give myself permission to leave and take care of myself.

At the time I had detailed plans to hang myself in the washroom at work, or to drown myself in the river using all the sleeping meds I had hoarded to assist myself in my quest for death. My suicidal ideation was so brutal and violent I could think of nothing else. I don't even know how I survived.

I feel like I could so easily be there again, because I still have the same stress responses to situations I feel anxious about. I also have an extraordinarily small stress threshold...even tiny things seem to set me off.

Anyhow...I will talk with my pdoc about all this next session.

...Aqua

My Letter to the Hospital

I wrote my letter to the hospital today. Like Dr. X. suggested I am going to "sit on it" for a few days before I send it. I am wondering if it's a bit harsh, but in fact I don't think it is harsh enough. In the original draft, at the end I explained that I recognize the facilitators are the messengers and not necessarily the instigators of the message...but they did deliver the messages in a way I was disgusted by, and they are part of the team that made the rules...so they are responsible. I always feel this need to "soften" the message when I give feedback...I hate that.

Anywho...here's the letter:

Dear XXXXX,

I am writing this letter to explain why I stopped attending the Assertiveness Class. I felt very uncomfortable with the way we were treated during the class. In particular I am referring to our being told we were not to see anyone in the class, outside the class. The reason given was the confidential nature of the classroom discussions. I agree that confidentiality is of utmost importance in all psychiatric treatment programs. I disagree that denying people the right to maintain their existing friendships is the way to achieve that goal.

Being told we, "...would be talked to" if we socialized with other participants outside of class, and we, "...would be talked to if we were caught doing our homework before class", and watching a participant being taken aside after class for collecting homework for another client, was extraordinarily paternalistic. It troubles me that in an assertiveness program, or any psychiatric treatment program, we were being treated as less than responsible adults. If the tables were turned, in similar circumstances, I cannot imagine a nurse or a doctor believing it was acceptable to be told who to see outside the classroom, or that their would be consequences if seen doing their homework.

In the Program there was an emphasis on the development of our learning socialization skills, growing new friendships, and maintaining the friendships we have. We were also encouraged to sign up for various other programs at the hospital. Many of us began seeing each other once we had completed the program. It is very unlikely some of us would not be in other classes together.

The current rule about not seeing participants of a class, outside the class, places an undue strain on many who struggle with managing to maintain the friendships they have gained. There are others who feel as I do. Some have pulled out of classes, or declined to attend particular classes, because they do not want to impact the friendships they have been working on. I do not like to think that people are not getting the treatment they need, because of a rule that I believe is to all encompassing.

I do recognize there are some groups, like Psychodynamic Group Therapy, or the Program Group, where seeing participants outside the group would be detrimental to all participants. In situations where the interpersonal dynamics within the group affect the quality of the therapy I absolutely agree with the rule about not seeing or contacting people in the group. In a classroom type group the situation is different.

The goal of maintaining confidentiality could be achieved in a different way, a way that values a patient's autonomy to develop and maintain friendships with whomever they choose, and in a way that recognizes that, if given the reasons for not discussing group information, they, as participants, have the capacity and the integrity to not discuss anything about the group, outside the group.

I suggest a better way to approach the confidentiality issue in the future would be to explain the importance of maintaining confidentiality. You can then explain that participants are not to discuss anything said, or done, in the classroom with anyone outside the classroom, even with other participants.

If you would like to share my thoughts with the rest of the team please do so, however I would prefer my name be kept confidential.

Feeling More Confident

I just came home from my therapy session with the good Dr. X. (No relation to the hospital or Assertiveness Class I was attending). We discussed the bad rules for participating in the Assertiveness Class I just quit. We have discussed this the past couple weeks. He has always been supportive of my perspective. Which I really appreciate.

Today we talked about what I could do, wanted to do etc. I explained my fears. I also expressed how angry I was at being treated so paternalistically. My dilemma moving forward is whether to speak up, or not to say anything and just move on.

I know if I say nothing I am going to be really angry at myself. I will feel that I let myself down. As well, I will feel like once again I sat by and let someone treat me disrespectfully and did nothing about it.

Dr X. mentioned one of his concerns would be that I might worry repeatedly about speaking up and the potential repercussions I may feel I might face. I think "worry obsessively" is what he meant to say...ha, ha...as that is my tendency. In the face of those fears I might decide to say nothing.

We talked about my worrying about not having access to the hospital's care if I needed it. Dr. X. said, "What kind of care would it be anyways given the way they are treating people"? He has a point. I think that made it clear to me that I need to say something. Also, he expressed to me the importance of speaking up in situations like this. The feedback can be especially powerful if we are someone who has a strong voice, one that is able to clearly relay how the offensive treatment is affecting us and others like us.

We decided that a well written letter was the way to go. I had thought a face to face discussion would be better, but Dr. X. and I talked about how that would probably end with the nurse countering my claims with a long explanation about why the rules are in place. I do not really care about that. I understand why. I just disagree about how to accomplish that goal.

Dr. X lent me a book with some chapters on communication and dealling with difficult people and suggested I put the letter aside for a couple days and re-read it before sending to ensure I am comfortable with what I wrote. I think that is a great idea. Maybe I will post the letter when it is done.

Have a great weekend!
...Aqua

Negative Rant

Okay...I realize my blurby about this blog talks about how positive my experience with therapy has been. That last post was pretty negative. But hey, I am depressed, what do you expect? I brought up my negative experience about the assertiveness group on a discussion board I belong to and was told by two different people that I should have stayed and brought up how I was feeling, why I was feeling that way, and what I saw as an alternative solution. Both people mentioned, and they are right, that nothing was acomplished by my just leaving.

I thought leaving would calm me down and make me feel less angry, irritated and anxious about the situation. Actually, I am feeling even more angry and anxious today because I am mad at myself for not being able to speak up....Argh!!!

Also, problem is, now I feel I not only owe the nurses an explanation, but that I my speaking up could help the rest of the people in that class, and the people coming to all the other classes. I know of at least 3 other people who have declined to go to courses at the hospital for this same reason. Maybe if I speak up more people will feel inclined to take advantage of the help available.

The irony of feeling unable to speak up, in a therapy group designed to help participants speak up, is not lost on me. I also recognize that quitting the group may not have been the best idea, when it could have been used as a valuable example of the exact circumstances in which I can never seem to speak up.

Those circumstances seem to be when an authority figure is the one I need to speak up to and when I feel it may become confrontational. I also have huge fears of being punished. So part of me fears I will not be treated well if I seek help with the hospital again. Must discuss in my therapy session today.

...Aqua

I am Sick, Not Irresponsible

I have been attending an outpatient "Assertiveness" class at the hospital the past 5 weeks. On the first class the nurses leading the class treated us like little kids and fearing we would be unable to play together without talking about "school", they laid down the law. They told us we could not see anyone in the class outside of class for the 10 weeks the class was on, and also that if we did not have our homework done, or if they saw us with someone from the class we would be "talked to".

Immediately I felt very angry...For a couple reasons:

• First, I am a fucking adult! If I wasn't a mental health patient I do not think you would be talking to me like this. I suspect instead I would be told, "The information said in this class is confidential, please do not discuss anything that occurs in this class, outside the class with anyone, even participants"
• Second, I am a fucking adult! If I weren't mental would you tell who I could/could not be friends with? I do sometimes hangout with a couple gals in the group. I met them in another outpatient program we were all in. That program was a 12-week depression group where one of the things we learned was that those with depression have a propensity to isolate...And socialization can help depression. So I meet people I feel comfortable with, we are encouraged to take other outpatient programs, we take them and are told not to socialize with others in class...fucking stupid and counterproductive if you ask me.
• I did not think it was appropriate for any healthcare professional to "threaten punishment" if I did not do as I was told.

Regarding seeing participants outside the class I would understand if it was a group therapy type group. In group therapy the people in the group and how they behave or react to you can often replicate important relationships in your life. If some people start forming alliances others might feel ganged up on. Also, the group misses out on seeing how you react positively to another group member, or negatively to another if you have already worked on the relationship outside the group.

This class was not group therapy though. It was a class. I think it was way out of line for them to tell us who to see. The point here really is that I have stressed about this for 5 weeks now. I was so stressed the past few nights I was having anger and anxiety attacks. So today I was supposed to go to the class. I worried about it all morning while visiting a friend. Finally I got the nerve to call and leave a message saying I would no longer be attending.

I am so glad I did that, but I got home and one of the nurses left me a message asking why. I am all stressed out again because, on one hand I want her to know why, but on the other I fear retribution if I need help at the hospital again, or when my name comes up for a group therapy group I am on a waiting list for...Sigh.

...Aqua

No Replacement For Therapy

First..this blog is in no way intended to be therapy, or be a replacement to therapy. I have no degree in psychology, I am not a psychologist or a psychiatrist. I am just a person looking to increase my functioning and live a full and meaningful life while trying to manage the symptoms of seemingly treatment resistant and chronic Major Depressive Disorder. Some of the content may upset others as I am going to be explicit about my thoughts of suicide and my struggle with depression. Be forewarned if that is something you have a difficult time with.

If you think you need therapy believe what you are thinking and seek professional help. Those niggling voices in our heads are often right. Well...they are often wrong too...but that is a whole different topic.

I just got back from my therapy session with Dr. X. I love my psychiatrist (pdoc). He is an extraordinary person who has taught me so many things. I have a connection with him like I have never had with any therapist or Dr. I ever seen. When I walk in his office and breakdown in tears because of my depression, or express my rage and anger at not getting well, he calms me so much. He is so relaxed, accepting, caring and compassionate. He accepts all my behaviours no matter how sad, distorted, or bizarre. He is genuine, honest and authentic. I believe he is my greatest role model. I can also honestly say that without him I would not be here today.

I was just reading my diaries from this time last year and despite my current insistence in therapy that I am not getting better, I realize I have made small leaps forward in terms of wellness. Just last week I told Dr. X. I was feeling suicidal and had taken to driving at extraordinary high speeds, praying my car would crash. I was feeling suicidal and I was driving erratically...but I realize now those suicidal thoughts were much less extreme compared to the constant and obsessive thoughts I was having this time last year.

Last year at this time I had been writing pages and pages of detailed and often violent descriptions of how I was going to kill myself, when I was going to and why I was going to. Reading those descriptions now I wonder how I survived. If you have never had this type of suicidal ideation you may not understand, but the thoughts are unrelenting and they come over and over and over...Almost like they trying to push you to act.

My last year's journal entries detailed how I would drag myself into my sessions afraid to say anything for fear of being hospitalized. Dr. X seemed to have an uncanny knack for knowing I was having suicidal thoughts and he would ask outright if I was having suicidal thoughts.
I could not lie to him as I respected him too much so I told him the truth. He would ask me my plans and would then ask me "Was I going to kill myself"...everytime I paused, thought about it, and realized they were just thoughts. Awful ones...but still only thoughts. Dr. X never hospitalized me like I feared he would.

My ability to openly share my suicidal thoughts when I am having them is definitely made easier by how strong my therapeutic alliance is with my pdoc. I first began to trust him more and more, when I started to recognize that he never judged me, never tried to challenge the validity of the thoughts...(they are MY thoughts after all), and he always asked me if I wanted to be hospitalized when the thoughts seemed to become overwhelming to me. I felt like a partner in these decisions. I began to really believe he would only hospitalize me if he thought I was a danger to myself.

I think another thing he did that allowed me to feel safe opening up, and facilitated my trusting him more, was make himself available to me. He gave me his pager number in case of an emergency. He explicitly told me to call if I thought I might try to commit suicide. Even though I knew I would never call him it was important to me to know I could if I needed to.

What I am trying to convey in my post is that ongoing trust and a strong sense that I am a partner working with my psychiatrist towards my wellness is a huge factor in my starting to get well. It took me a long time to learn to trust. That is something I struggle with. He won me over by continually showing he was ALWAYS caring and worthy of my trust.
...Aqua