Saturday, July 30, 2005
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.
Friday, July 29, 2005
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.
Saturday, July 23, 2005
Anywho...here's the letter:
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.
Friday, July 22, 2005
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!
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.
Thursday, July 21, 2005
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.
Tuesday, July 12, 2005
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.