Monday, July 23, 2007

Preparing for my Therapy Session Tomorrow

So many feelings, thoughts, worries, constant ruminations have rapidly passed through me this week that I think I need to write out what I want to say so I have some understandable piece of information to share with my pdoc tomorrow. Also, I don't know why, but I feel it is not my place to ask Dr. X. to reveal some of these maybe I can do it on paper.

Throughout the week I've been writing my ruminations out as they happen, They are coming at me rapidly and feel intrusive, as opposed to my consciously trying to think about them. I wake and the flood of thoughts starts. Often I can't remember what it was I was thinking by the time I get to my session, or something there distracts me from what I wanted to ask/ I'm going to try to consolidate some of these:

1) Something simple Dr. X. said in my last session triggered massive stress about going to the hospital. Although, when he said it, I felt he was being thorough and I was really being cared for.

I'll paraphrase: He said, the hospital might be a good place for me to be observed by others in case he has missed something. Panic and distrust set in a couple days later.

I started wondering what Dr. H. said about me 2 yrs ago, (he was the Pdoc who interviewed me for ECT and my stay at the hospital), then I worried about what Dr. R. (Pdoc at a couple outpatient programs I attended) said about me, then I started worrying I would get a Pdoc in the hospital who was not my advocate, like I feel Dr. X. has been, then I started to worry about being diagnosed with a personality disorder, or some other uninsurable illness, or worse they would miss my depression altogether and I would feel like a fraud, because my mood is so bizarre, labile and reactive to things around me, then I started to worry about my insurance company seeing this as a good opportunity to cut me off, then I started worrying about ending up without enough income to take care of myself....and it just kept getting worse from there.

What did these Dr.s' say about my depression? Did they send Dr.X. a report? If so, can I know what was in them?

2) I am afraid if I go into the hospital the same thing as last time will happen and it will misrepresent my depression and how bad I usually feel. This is what happened last time I went in for ECT.

My mood lifted almost immediately, long before ECT could explain it. Placebo effect? I'm not depressed? Something else is going on? Who knows why?.. .although I wonder who can tell if it was ECT that affected my mood during the latter part of my stay after receiving the requisite # that usually affect people's mood. Also, when I review my mood diary my mood did stay up for a few weeks after ECT.

What if I get some dogmatic, or unknowledgeable Pdoc and they really do miss that I really am depressed. I get so much feedback that I don't seem like I am depressed on the outside. This I can't even understand myself. Even the Occupational Therapists who see me at the studio keep saying more than once or twice that "[I am] so high functioning when I am in class teaching, or involved in other group projects, that it is hard to see [I am] unwell"...except that I've been breaking down in tears most of the time I meet privately with I feel confused by their comments.

My mood swings feel out of my control. The only thing I can liken them to is a, seemingly, inactive volcano. It sits and looks innocuous, like a beautifully functioning mountain. It seems safe and normal for a period of time. All the villagers living at the base of the volcano think everything is fine and then suddenly boom. The thing explodes and like the lava my internal depression comes flowing out, much to the surprise of those around me. (other than the people who really know me...they KNOW the lava is always at the surface). How the hell can I switch on and off like I do and this be an illness and not something I am in control of?

Also, I know that if I went into the hospital and my depression was dismissed as not real I would be even more confused and depressed than I feel now. I have struggled, (unsuccessfully I might add), for so long to accept, what Dr. X. tells me...and I trust him. What about someone I do not trust?

What happens if all that falls apart and I have to start again believing or accepting some other diagnosis? The majority of me still believes all this is my fault, that it is my own self that continues to make me sick.

3) I am becoming increasingly paranoid:

(but if I really am is it that I have some insight into the idea that some of my thoughts might not be real? So I feel here, like with my depression, my symptoms are inconsistent with the idea of feeling paranoid or depressed)

  • That the Clubhouse staff thinks I am not fit for teaching the next session due to all the breakdowns I keep having in their offices and when talking with other members I trust.
  • At the same time I feel they see my reactive "functioning" mood as a sign that I'm in need of no help. (I know...another contradiction). The constant reminder by the OT's that my "high functioning" is in direct conflict with my diagnosis is stressing me out beyond belief. I feel like I'm fake, or my depression is a delusion, or something else...I don't understand what.(I hate the terms high/low functioning, but don't know how else to say what they are referring to)
  • That my sister's, my step mom and husband are colluding against me...I have overheard them talking about me on the phone and my husband has told me they talk about my treatment making me worse.
  • I have a lot of internal conflict about whether therapy is good for me too. I have never felt cared for like I do in my sessions and maybe that is unhealthy? Maybe I stay sick because I have no other source that cares in the same way and I am afraid of losing that support? I often wonder if I were to have no reminders I was Pdoc, no medicine, no mental health community (i.e. Art Studios, my friends, etc)...if I would just magically get well.

4) I feel like my mood is cycling so fast right now:
As of tonight I will be off my last medication. I don't think my mood cycling is related to that though....I think it's related to my above worries. I'm up for class, feel more energy at the start of the day, get anxious, or irritated, agitated, or enraged and depressed, as the day goes on...sometimes within an hour or so of feeling a different way/sometimes all at the same time. My sleep is very interrupted. I wake up and all the above thoughts go over and over in my brain. I feel better in the early morning (more awake)....but worse as the day progresses and exhausted by 1 or 2 still. I am having difficulty concentrating and making tons of mistakes everywhere; at home, with my art and my driving is scary because I seem to disappear and can’t focus.

  • Eg.: On Friday I went into the clubhouse to do my own art (no teaching that day). When I went in I felt so irritable...on the verge of rage, but I forced myself to go thinking I would feel better if I could get distracted by my art. While there I was asked by one of the OT's when I would be available to volunteer after the Aug 6-17th break (they're closing for 2 weeks). I just broke down crying. I feel so confused about how I am feeling. On Thursday at a meeting I felt like I was going to blow up inside.

The feeling like I'm in crisis, but no one is noticing. I have explained to them that I may go into the hospital. I want to be fair to them so they can make up the schedule and decide if I am allowed to help teach drawing classes and be a Mentor for others in September or not. I don't understand what they want me to say when I don't even know if I will be in the hospital or not.

I am confused about Dr. X.'s suggestions of a hospital stay. I have no idea if he is serious or if it's just an idea, and if he is, when it would I don't know what I can/cannot commit to. (ask him for clarification and a more definitive plan) Also, his bringing up the bipolar/ECT study and cognitive problems makes me wonder if ECT is a good idea. Is that what he was saying? I know I don't have bipolar, but Dr. X. has said I have a "bipolarity" to my depression. Does it concern him I may lose some more cognitive abilities if I have ECT?

So, to conclude: I feel like I appear "normal" on the outside to most people, and explosive, depressed, suicidal, irritated, can't think straight, on the inside and every once in a while that volcano of emotions allows itself to come to the surface.

The explosions usually happen: a) when I'm on my own, b) when I'm talking with someone I feel safe opening up to. c) When I feel really misunderstood and/or the severity and impact on my life my depression has had on me is dismissed or misunderstood. Although I feel like I cannot control when they explode to the surface I must be able to to some degree, otherwise how am I seemingly okay one minute and not the next?

I was thinking last night how some people believe in God - something else being in control of their destiny. It is like I cannot accept I have a mental illness and that I have little control over some aspects of how I feel or act. I feel like it is my personal responsibility to make myself feel better and I am failing miserably. When I go high....I can see it is like a light switch gets turned on and I did nothing to affect my high mood, but when I am low, I feel like I did, or am doing, it to myself.

God, I need a shut off switch on my brain.

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