Saturday, November 24, 2007

Breathe Deeply This Magic Elixir

Early last week I had one of those dreams that seem to be passing me messages. The kind I know I need to listen to:

I had 2 kids and an ex-husband. The ex-husband was violent. He drove by the kids and I and then he began chasing us. After a long, terrifying chase we got away.

We went home. It was supposed to be safe, but I worried the ex would find us. The doorbell rang. I was sure it would be him.

I told my husband not to answer the door, but he did anyways. It was my brother. He too was violent. He was also mentally ill. He had schizophrenia.

My husband invited him in. He needed a place to stay. I was scared.I didn't think it was safe to have him in the house.

I opened the door to the basement and I pushed my brother into the darkness. The basement was terrifying. I locked the door behind me.

After a few hours I got up because I knew my brother would be scared. My husband gave me an elixir. "Place two drops in your hair and it will put him to sleep", my husband explained. I was worried I would breathe some in. Just before I went downstairs I placed two drops in my hair. When I reached him he got up and came to hug me.

As he hugged me he smelled my hair. He loved the smell and breathed in deeper; as he did he began to slip into a deep sleep.

I felt so sad that I had to drug him to feel safe, but it worked. I did feel safe and I fell asleep as soon as I crawled into bed.
  1. First I have no exhusband and no kids. My pdoc pointed out that a very close friend of mine has 2 kids and a husband so evil he would stalk her if she ever left him...(well the "evil" part was my word).
  2. I am my brother. I'm mentally ill and sadly I feel I have a huge and uncontrollable capacity for rage when severely ill and I am really afraid I may have a capacity for violence in that state.
  3. I especially have violent and obsessive suicidal thoughts in this state. Therfore the violent men may represent those suicidal thoughts.
  4. I think him having schizophrenia represents me having an mental illness that is clearly an illness and accepted by mainstream people as an illness (vs. depression often being seen as a lack of strength of character, or as my fault, or its change within my grasp).
  5. Maybe I am the brother because my Dad was full of rage and anger and sometimes violence. I see that trait as masculine. I hate and fear that side of myself.
  6. Pushing my brother into the basement = my fall into my scariest depression...angry, agitated, violent suicidal thoughts...and there is no escape when I am there...the door is locked.
  7. The locking of the door may also represent locking out my mental illness (the female me feels safer when the door's locked).
  8. "I felt so sad that I had to drug him..." = my sadness about needing medication to help me and about being mentally ill in the first place.
  9. However, on some level "the elixir" represents my desire for a drug that will calm me, allow me to sleep and to feel safe.
  10. "Place two drops in your hair and it will put him to sleep"...reminds me of the magic potion in the old fairytales Snow White, Sleeping Beauty, The 12 Dancing Princesses etc. In these tales each falls into a deep "deathlike" sleep. I find it interesting that I am both the one afraid I will fall asleep (i.e. afraid of death) and the one transferring the "death" elixir to myself (i.e committing suicide). This whole transferring of the elixir represents my ambivalence about suicide.
  11. The metaphorical me (the mentally ill brother) loved me and reaches out to hug me. It is poignant that I am killing my loving self. Interesting that such a loving gesture comes from one I perceive to be so violent. I guess all that violence goes when you die...but all the goodness goes when you die too.
  12. The metaphorical me loved the smell of me...I love the idea of death setting me free.
  13. Also, he breathed that death in deeply. He really did want to die. Do I?

Wednesday, November 21, 2007

Inertia and Shame

I often notice myself avoiding eye contact with Dr. X. Almost every appointment I begin by explaining how I am feeling and what has taken place the past week. During this time I always look away, staring at the corner of the door, or the books on his shelf; looking anywhere else but at the person I am talking with. During this time I almost always feel ashamed of myself. Ashamed for not getting better, ashamed of the way I act, ashamed for not doing the things I know I need to do to get better; like exercise, eat better, and spend more time with other people.

Usually about half way through my session I begin to feel less anxious and my gaze moves towards Dr. X's face. Yesterday this never happened. I spent almost my whole appointment staring at the bookshelf. I recognize this is a problem. My avoidance of eye contact is a reflection of my fears of being rejected by Dr. X., my low self esteem, and how much guilt and shame I carry inside me.

The last two sessions I have noticed that my chair has been positioned so it is directly facing Dr. X. If I sat in the chair as it was I would have a hard time avoiding Dr. X. Both times I have repositioned my chair so it faces away from Dr. X. I never thought he might have positioned the chair facing him on purpose until last night. Now that I think about it I think he intentionally positioned the chair so, when I sat down, I would have no choice, but to face him.

I have thought about this before. Part of why I move the chair is because I feel like I am too close to him (proximity wise) when facing him. I need more space. This feeling happened when I first began seeing him in another office. I began thinking he was moving closer and closer to me to test the veracity of my claim that I felt uncomfortable when others got to close to me. Now that I know him I do not think he was doing that. I believe he simply became more comfortable with me over time. I do however think he repositioned my chair the last few weeks. The chair was too sharply angled towards him.

This post is not to fault him for that, but to help myself participate in his scheme. I think it is unhealthy for me to avoid eye contact with him. I believe my doing this only serves to reinforce the feelings of shame and guilt I have about my increased inertia. My feeling this shame and guilt is like my buying into the scorn others heap on me about my not trying hard enough, not doing what I need to do to get better. This shame about who I am when severely depressed ignores such depressive symptoms as the severe inertia and amotivation that encompasses me when I am depressed and even the fact that the shame itself is a symptom.

I am going to address this in my next session. I have a difficult time challenging my avoidance of eye contact when I am in the moment. It is only afterwards that I regret missing the opportunity to address it. I will ask Dr. X. to help me take a behavioural approach to this problem, to help me redirect my gaze towards him when I speak; especially when I speak of things I feel bad about.

I believe if I can look at him while I tell him the things I feel ashamed about it may help dissipate those feelings of shame and guilt. I also believe by looking at him while talking I am asserting my self esteem and acknowledging that it is my illness, and not some lack of character on my part, that keeps me from becoming well. I am hoping a behavioural approach to this situation will reduce the amount of self-stigmatization I feel about having treatment resistant depressive symptoms.

Thursday, November 15, 2007

Rating my Mood

"I think you are telling me you are feeling better than you actually are". When Dr. X spoke these words in my session last week they struck me as funny and I started to laugh. Why would I do that? It seems more likely I would tell him the opposite; that I am feeling worse than I am, out of fear that I would be told I was better before I felt ready to take on more responsibility.

I thought about it. I am so afraid I will lose his support; or that he will become so bored with my ongoing struggle and my seeming inability to motivate myself to actually DO something to help myself. Read: socialize, call my sisters', exercise, eat well, i.e. no more bowls of cereal at night, mashed potatoes, chocolate, chips, bread, all those things that are threatening to pack on the pounds, but seem, at the moment I eat them, to fulfil some void inside me.

At the moment he suggested I may be sugar-coating how I feel I thought maybe that was the case. The past three weeks I had come into my appointment, sat down and told him I thought, while my irritability (hostility/rage) and anxiety were worse, I felt my mood was a bit better. Immediately upon stating this I would start to cry uncontrollably. It did not seem far fetched that I was I was trying to protect him. To give him hope. To protect myself by telling him I was on the road to recovery.

We talked about this again in my appointment this week. I no longer think that is what was happening. I think there is a component of my mood that is feeling a bit better. I measure my mood in very strict terms, rating 5 things: mood, anxiety, irritability, fatigue and sleep. Each of these has a clearly defined rating system:

Mood: 1 suicidal, 2 suicidal thoughts, 3 severely depressed, labile or cycling mood, 4 depressed, 5 flat/apathetic, 6 feeling okay, (Target = 7...Feeling good most of the time with moments of feeling great), 8 feeling really high, 9 hypomanic, 10 manic

Anxiety: 1 panic attacks, 2 severe anxiety attacks, 3 severe-moderate anxiety attacks, 4 severe anxiety(no breathing problems), 5 moderate anxiety, 10 none

Irritability: 1 rage, 2 hostile, 3 agitated, 4 irritated, 5 moderate, 10 none
Fatigue: 1 extreme, 5 moderate, 10 hyperactive

Sleep: Number of hours

When I review my mood since I have been taking 800mg Tegretol I notice 2 things: my "Mood" fluctuates between 3 and 4, whereas for most of the last 6 years it has been sitting mostly at a 2 and occasionally a it is up a bit. Also, I have noticed my mood has not been cycling as much. This is a relief. So I think, although my mood is not good it is clearly better than it was. That too is a relief.

If I am so relieved, why do I burst into tears upon telling Dr. X I think I am feeling a bit better? I believe it is for two reasons. I cry because it is safe to cry in his office. He accepts me, so the crying is like me relieving all those tears that build inside me throughout the week. All the tears I cannot cry. The other reason is because I am afraid. I am afraid that getting better means I will lose Dr. X and his support. I need to trust him when he says I can see him when I'm well. He even says that may be the most important time to see him.

Wednesday, November 07, 2007

5 Reasons I Look Forward To Therapy

1) My pdoc really "gets" me. I always (99.9% of the time) feel listened to, cared for and understood.

2) If I I feel misunderstood or not heard by Dr. X. I feel he has proven himself to be so trustworthy that I feel 100% safe addressing my concerns. My best learning has taken place when there has been a misunderstanding that I am able to address. I believe that the best therapy happens, not through the words we speak, but through the behaviours that take place between us and the therapeutic relationship we are building and developing.

3) I can be raging, agitated, anxious, suicidal but after I am with my pdoc for 5 or 10 minutes I almost always begin to feel calm. It feels magical, but I think it is his calm presence that invites calmness in me. When I am extremely anxious I sometimes try to visualize myself sitting across from him in his office, hoping I can capture some of that energy outside our sessions.

4) It is clear to me that my pdoc loves what he does. Sometimes I sense a childlike joy when we are working together. It's not just when I am feeling better either. It seems to be when we both come upon an idea or a solution that will help me.

5) He accepts the mad, sad, angry, glad, close to hypomanic, irritable, dull, and wide awake me. Basically he accepts me any way I am. Never judges, never seems surprised, or shocked. Always seems to like me however I am. That makes me feel safe to be open and honest about everything I feel and everything I do.

Monday, November 05, 2007

5 Beautiful Things

From here on in I am going to try to make at least half my posts positive and life affirming. This blog has dealt with so much sadness, anger and anxiety that I think, in order to push my mental health into a healthier space, I need to make at least some of it life affirming.

Dr Shock MD PhD in his/her post, "1 Myth about depression mostly not covered", wrote a post in response to my questioning the myth that states "depression is a treatable illness", acknowledging that this is not always the case.

Some people do not get well with treatments for their depression. For those people it is important to help them live with chronic depression, in much the same way others with other chronic medical conditions (heart disease, diabetes etc.) learn to live with there conditions.

He talks about many of the things my pdoc does: creating a meaningful life in spite of being depressed, mindfulness, and creating a sense of well being in spite of my illness.

It's an interesting post. Anyways, I've decided to show another side of myself.

Here are "5 Beautiful Things" that create meaning in my life:
1) Beautiful Speech
(The below speech by Nelson Mandela was originally written by Marianne Williamson):

"Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure. It is our light, not our darkness, that most frightens us.

We ask ourselves, who am I to be brilliant, gorgeous, talented, and fabulous? Actually, who are you not to be? You are a child of God. Your playing small doesn't serve the world. There's nothing enlightened about shrinking so that other people won't feel insecure around you.

We are all meant to shine, as children do. We are born to make manifest the glory of God that is within us. It's not just in some of us, it's in everyone. And as we let our own light shine, we unconsciously give other people permission to do the same. As we are liberated from our own fear, our presence automatically liberates others."

2) Beautiful Art:
Beata Beatrix. 1864-1870. Oil on canvas. Tate Gallery, London, UK. More. Dante Gabriel Rossetti. (Above image)

3) Beautiful composer with beautiful music

4) Beautiful City

5) Beautiful Song (although I cannot figure out how to get these videos to not sound like mickey mouse is singing)